Kansas Pandemic Influenza Preparedness and Response Plan · 2020-01-03 · Kansas Pandemic...
Transcript of Kansas Pandemic Influenza Preparedness and Response Plan · 2020-01-03 · Kansas Pandemic...
KANSAS PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE PLAN
Version 2.3.3 January 2020
Kansas Response Plan Biological Incident Annex
Attachment 1
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 2
Table of Contents
Introduction .................................................................................................................................................. 4
Situation ........................................................................................................................................................ 4
Influenza Background ............................................................................................................................... 4
Pandemic Influenza as an Emergency ....................................................................................................... 5
Planning Assumptions and Considerations ................................................................................................... 5
Concept of Operations .................................................................................................................................. 9
Organization of the Kansas Pandemic Influenza Preparedness and Response Plan ................................ 9
Interpandemic Phase .............................................................................................................................. 10
Community Resilience and Incident Management ............................................................................. 10
Biosurveillance .................................................................................................................................... 17
Surge Management ............................................................................................................................. 22
Information Management .................................................................................................................. 25
Countermeasures and Mitigation ....................................................................................................... 28
Alert Phase .............................................................................................................................................. 34
Community Resilience and Incident Management ............................................................................. 34
Biosurveillance .................................................................................................................................... 36
Surge Management ............................................................................................................................. 38
Information Management .................................................................................................................. 39
Countermeasures and Mitigation ....................................................................................................... 40
Pandemic Phase ...................................................................................................................................... 42
Community Resilience and Incident Management ............................................................................. 42
Biosurveillance .................................................................................................................................... 45
Surge Management ............................................................................................................................. 47
Information Management .................................................................................................................. 49
Countermeasures and Mitigation ....................................................................................................... 50
Transition Phase ...................................................................................................................................... 52
Community Resilience and Incident Management ............................................................................. 52
Biosurveillance .................................................................................................................................... 53
Surge Management ............................................................................................................................. 53
Information Management .................................................................................................................. 53
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 3
Countermeasures and Mitigation ....................................................................................................... 53
Plan Development and Maintenance ......................................................................................................... 54
Authorities and References ........................................................................................................................ 55
State Legal Authority............................................................................................................................... 55
Glossary ....................................................................................................................................................... 57
Acronyms and Abbreviations ...................................................................................................................... 58
Appendices .................................................................................................................................................. 60
Appendix A –Health Emergency Activation Levels ................................................................................. 60
Appendix B – Crosswalk of Activities ...................................................................................................... 61
Appendix C – State Preparedness Committees ...................................................................................... 62
Appendix D – Coordination List .............................................................................................................. 62
Appendix E – Family (Home) Care for Symptomatic Individuals ............................................................ 64
Appendix F – Internet Sites Referenced ................................................................................................. 66
Appendix G – HHS Vaccine Priority Recommendations .......................................................................... 67
Appendix H – Local Pandemic Influenza Response Checklist ................................................................. 69
Appendix I – State Pandemic Influenza Checklist ................................................................................... 70
Appendix J – Community Disease Containment Standard Operating Guide .......................................... 74
Appendix K – Diagnostic Assays during Pandemic Influenza .................................................................. 74
Appendix L – KDHE ILINet Sites ............................................................................................................... 76
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 4
Introduction Influenza viruses are unique in their ability to cause sudden illness among humans in all age
groups on a global scale. The importance of influenza viruses as biologic threats is due to a
number of factors including the high degree of transmissibility, the presence of a vast reservoir
of novel variants (primarily aquatic birds) and the unusual properties of the viral genome. The
infamous “Spanish flu” of 1918-19 was responsible for more than 20 million deaths worldwide,
primarily among young adults. Mortality rates associated with recent pandemics of 1957 and
1968 were reduced in part by the use of antibiotic therapy for secondary bacterial infections and
aggressive supportive care of infected patients. However, these later pandemics were associated
with high rates of morbidity and social disruption. Although the 2009 influenza A H1N1
pandemic influenza virus had a low pathogenicity, mortality was reduced in part due to national
implementation of community disease mitigation measures developed as part of pandemic
influenza planning. The Centers for Disease Control and Prevention (CDC) estimates the
economic loss associated with the next severe pandemic will be in the billions of dollars.
Experts agree an influenza pandemic is inevitable. To prepare for the next pandemic, the Kansas
Department of Health and Environment (KDHE) Bureau of Community Health Systems
(BCHS), in cooperation with local and state partners, has developed this Kansas Pandemic
Influenza Preparedness and Response Plan, which provides an overview of strategies to reduce
pandemic influenza-related morbidity, mortality, and social disruption in the state.
Situation
Influenza Background
Influenza is an illness caused by viruses that infect the respiratory tract of humans. Signs and
symptoms of influenza infection include rapid onset of high fever, chills, sore throat, runny nose,
severe headache, nonproductive cough, and intense body aches followed by extreme fatigue.
Influenza is a highly contagious illness and can be spread easily from one person to another. It is
spread through contact with droplets from the nose and throat of an infected person during
coughing and sneezing. The period between exposure to the virus and the onset of illness is
usually about two days, although it can range from 1-5 days. Patients are most infectious during
the 24 hours before the onset of symptoms and for 3-5 days after onset of illness. Influenza is
highly contagious and persons who are sub-clinically infected (show no signs of illness) can
transmit the virus. Influenza is not an endemic disease, but in the northern hemisphere annual
epidemics usually occur from December through April.
There are two types of influenza viruses that cause significant disease in humans: type A and
type B. Only influenza A has been known to cause pandemics. Influenza A viruses are
composed of two major antigenic structures essential to the production of influenza vaccines and
the induction of immunity: hemagglutinin (H) and neuraminidase (N). Influenza A viruses are
unique because they can infect both humans and animals; most influenza A viruses are
considered to be avian in origin. Worldwide avian influenza control efforts are coordinated by
the World Organization for Animal Health (OIE). The state animal agency (i.e., Kansas
Department of Agriculture, Division of Animal Health (KDA)) would play a role in these efforts.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 5
Pandemic Influenza as an Emergency
Pandemic influenza is a unique public health emergency. No one knows when the next influenza
pandemic will occur. However, when it does occur it will likely be with little warning. Since the
novel virus may be identified in any region of the world, experts believe that no more than 1-6
months would pass from the identification of a novel influenza virus to widespread outbreaks in
the United States. Outbreaks are expected to occur simultaneously throughout much of the
nation, so re-allocation of human and material resources is not a practical option.
Historically, influenza pandemics have occurred in ‘waves’ and it is expected this will happen
with future pandemics. A pandemic wave (a time period during a pandemic when increased
numbers of people are becoming sick) can last as long as 6-8 weeks. As a result of this, the
World Health Organization (WHO) and the CDC have defined phases of a pandemic in order to
facilitate coordinated plans. These actions are described throughout this plan and are
summarized on the Flu.gov website (www.flu.gov) under the ‘HHS Pandemic Influenza Plan’
(https://www.cdc.gov/flu/pandemic-resources/pdf/pan-flu-report-2017v2.pdf). On the basis of
experience from recent influenza responses, CDC has updated the framework to provide greater
detail and clarity regarding pandemic influenza planning. The document, Updated Preparedness
and Response Framework for Influenza Pandemics, is available at
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6306a1.htm.
In addition, Kansas is continually integrating the use of federally defined Public Health
Emergency Preparedness and Healthcare Emergency Capabilities and the influenza planning
‘intervals.’ Tied to surveillance, this integration will allow for a timelier response at the local
and state levels. This “trigger” system further sensitizes the response infrastructures and ties
actions directly to those already linked to the Pandemic Severity Assessment Framework
(PSAF). Decision process algorithms may be utilized in conjunction with both local and state
standard operating guidelines to better orient the state response to a pandemic.
Planning Assumptions and Considerations The following are assumptions to provide a basis for preparedness activities pertaining to
pandemic influenza:
• Pandemics may have very mild or very severe morbidity, mortality, and economic
impacts to individuals and society. Authorities should be ready with a scalable response
system to address this spectrum. This plan intends to address a severe pandemic scenario
and allows for such scalable response implementation based upon the specifics of the
pandemic.
• Influenza pandemics are expected but unpredictable and arrive with very little warning.
• Outbreaks can be expected to occur simultaneously throughout much of the U.S., making
shifts in human and material resources that usually occur in response to other disasters
untenable.
o Localities should be prepared to rely on their own resources to respond.
o As with many public health emergencies, the effect of influenza on individual
communities will be relatively prolonged (weeks to months) in comparison with
other types of disasters.
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• Anticipating a high attack rate associated with severe pandemic influenza viruses, the
number of persons affected in the U.S. is expected to be similarly high and it is estimated
that:
o Up to 200 million people will become infected
o Between 38 million and 89 million may be clinically ill
o Between 18 million and 42 million may require outpatient care
o Between 314,000 and 734,000 may require hospitalization
o Between 89,000 and 207,000 may die
o The national estimates for pandemic infections, illnesses, outpatient visits,
hospitalizations, and deaths are taken from Meltzer MI, Cox NJ, Fukuda K. The
economic impact of pandemic influenza in the United States. Emerging Infectious
Diseases 1999;5:659-71. Available at http://wwwnc.cdc.gov/eid/article/5/5/99-
0507_article.htm.
• In Kansas it is estimated that, in a severe pandemic:
o Between 229,000 and 535,000 persons may require outpatient care
o Between 5,000 and 11,700 may require hospitalization
o Between 1,200 and 2,700 individuals may die
o Kansas estimates are taken from a software program that uses 2010 census figures
to calculate state-specific numbers. Meltzer MI, Shoemaker HA, Kownaski
M, Crosby R, 2000. FluAid 2.0: A manual to aid state and local-level public
health officials plan, prepare and practice for the next influenza pandemic (Beta
test version). Centers for Disease Control and Prevention, U.S. Department of
Health and Human Services. Though a new model is not available, KDHE
anticipates that the current numbers will be higher especially in a severe
pandemic.
• Healthcare workers and other first responders may be at higher risk of exposure and
illness than the general population, further straining the healthcare system.
• Effective prevention and therapeutic measures, including vaccine and antiviral
medications, will likely be delayed and in short supply.
• Widespread illness in the community could increase the likelihood of sudden and
potentially significant shortages of personnel in other sectors that provide critical public
safety services.
• Public and private partners have been brought into the planning process and systems for
communications among the partners are in place.
• Pandemic influenza planning will be integrated into all-hazards preparedness activities.
• Influenza-like illness (ILI) surveillance is already in place.
• Mass prophylaxis clinic protocols are developed.
The following compose the anticipated federal roles in pandemic influenza preparedness and
response:
• Disease surveillance in the U.S. and globally
• Epidemiological investigation in the U.S. and globally
• HHS and CDC will utilize the Influenza Risk Assessment Tool (IRAT) to make an
assessment of potential pandemic risk for a novel virus on the basis of the likelihood of
an emergency and the public health impact if it were to emerge.
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• After a novel virus has achieved efficient and sustained transmission, HHS and CDC will
utilize the Pandemic Severity Assessment Framework (PSAF) to characterize the
potential impact of a pandemic relative to previous influenza epidemic and pandemic
experiences and share those conclusions with state health officials.
• Development and use of diagnostic laboratory tests and reagents
• Development of reference strains and reagents for vaccines
• Vaccine evaluation and licensure
• Determination of populations at highest risk and strategies for national vaccination and
antiviral medication use
• Recommendations on measures to decrease transmission (such as travel restrictions,
isolation and quarantine)
• Purchase and deployment of federal cache of antiviral medication and vaccine
• Evaluation of the efficacy of response measures
• Deployment of the Commissioned Corps Readiness Force and Epidemic Intelligence
Service officers
• Medical and public health communications to the public and health and medical sector
organizations
• Identification and training of Principal Federal Officers (PFO) and Federal Coordinating
Officers (FCO) to work with State Coordinating Officers (SCO) during pandemic
response
• Provision of federal guidance and expectations for exercises
The following compose the anticipated state roles in pandemic influenza preparedness and
response:
• Identification of statewide public and private sector partners needed for effective
planning and response
• Development of key components of the pandemic influenza preparedness plan; planning
and coordination, situation monitoring and assessment, prevention and containment,
health system response, and communications
• Epidemiologic investigations and analysis statewide
• Identification of priority groups for vaccination based on federal recommendations
• Maintenance of influenza surveillance system, and development and implementation of
enhancements as appropriate
• Maintenance and storage of state purchased antiviral medication and equipment cache
• Logistics planning for distribution of antiviral medications and vaccine
• Integration of pandemic influenza planning with other planning activities conducted at
the local and state levels
• Coordination with local jurisdictions to ensure development of local plans and guides as
outlined by the state plan and provision of resources, such as templates to assist in the
planning process
• Development of data management systems needed to implement components of the plan
• Participation with local jurisdictions in developing, exercising, and evaluating their plans
• Coordination with adjoining jurisdictions and states
• Training state staff on roles and responsibilities identified in this plan
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• Evaluating exercises and developing improvement plans to maximize state response
coordination
• Cooperation with federal partners to enhance laboratory monitoring of seasonal influenza
viruses
• Conducting year-round surveillance activities, seasonal influenza analysis, and testing to
detect novel subtypes of influenza viruses
• Education of laboratory staff on safe handling of specimens suspected to contain novel
influenza viruses and surveillance for influenza-like illness among laboratory personnel
The following compose the anticipated local roles in pandemic influenza preparedness and
response:
• Identification of local public and private sector partners needed for effective planning and
response
• Coordination with adjoining jurisdictions
• Maintenance and exercise of the Emergency Support Function (ESF) 8 component of the
County Emergency Operations Plan (EOP), the Biological Incident Annex (BIA), and
associatied implementation guides including the Mass Dispensing Standard Operating
Guide (SOG), Public Information and Communication SOG and other guidance and
policy documents, as appropriate
• Continue to emphasize the importance of annual influenza vaccination and the routine
administration of pneumococcal vaccine for recommended risk groups during the
preparation phases of the pandemic
• Administer a system to estimate the number of persons in priority groups for vaccination
and deliver vaccine
• Assure the security of influenza vaccine during storage and delivery when it becomes
available
• Plan for the potential of civil unrest due to resource scarcity
• Maintain the Public Information and Communication SOG and ensure coordination of
information with local emergency management coordinators, hospitals and at-risk
populations
• Maintain media relations at the local Joint Information Center (JIC)
• Maintain a 24/7 contact list of key health department staff, local partners and media
contacts
• Work with the Kansas Health and Environmental Laboratories (KHEL) to address local
laboratory surge capacity issues
• Train personnel in the management of respiratory specimens during an influenza
pandemic
• Institute surveillance for influenza-like illness among laboratory personnel working with
influenza virus
• Plan for and implement laboratory surge capacity to manage increased numbers of
requests for influenza testing
• Send selected specimens from possible pandemic influenza patients to KHEL
• Clinical laboratories that receive diagnostic specimens from patients with suspected novel
influenza (based on clinical and epidemiologic data) should contact KDHE
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Concept of Operations
Organization of the Kansas Pandemic Influenza Preparedness and Response
Plan
This plan is organized according to the World Health Organization (WHO) Pandemic Phases
along with the corresponding CDC Intervals. The following preparedness domains are described
in each applicable phase/interval: community resilience and incident management,
biosurveillance, surge management, information management, and countermeasures and
mitigation. This plan has been developed in such a manner as to be scalable to the pandemic
incident as it presents. While the plan primarily addresses a scenario of a severe pandemic, the
activities and functions may be activated at a lower capacity to address more mild pandemics.
All state and local governments are required to have an emergency operations plan, which
addresses all hazards. However, pandemic influenza is likely to pose unique challenges that may
not be addressed in current emergency management plans. To address these challenges,
emergency management plans should incorporate a Biological Incident Annex (BIA) maintained
by local and state health agencies that include specific pandemic influenza elements. Some of the
issues addressed within a BIA include:
• Medical services and healthcare workers may be overwhelmed during an influenza
pandemic, and medical supplies may be insufficient.
• Healthcare workers may not be able to provide essential care to all patients in need.
• Unlike the typical disaster, because of increased exposure to the virus, essential
community services personnel such as healthcare personnel, law enforcement officers,
firefighters, emergency medical technicians and other first responders may be more likely
to be affected by influenza than the general public.
• An influenza pandemic may also pose significant threats to the human infrastructure
responsible for critical community services. This threat will be due in part to widespread
absenteeism in the workforce. Significant decreases in the workforce could impact
distribution of food, home meal deliveries, day care, garbage collection, utilities and
other critical services.
• Physical infrastructure may be threatened or destroyed if there is civil disorder.
KDHE-BCHS staff members have developed local SOG templates and state SOGs that address
details of implementing local and state response plans, including contact lists for partner
organizations and resource owners, step-by-step operational guidelines, job action sheets for key
staff and notification procedures. Local health departments have completed the Mass Dispensing
SOG, which describes how mass vaccination and pharmaceutical dispensing clinics will be
conducted. They have also completed SOGs that describe specific actions regarding community
disease containment, public information and continuity of operations.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 10
World Health Organization
(WHO) Phases
Centers for Disease Control & Prevention (CDC)
Intervals
Interpandemic
Phase
Period between
influenza
pandemics
Investigation: Investigation
of novel influenza A infection
in humans or animals
Identification of novel influenza A
infection in humans or animals anywhere
in the world with potential implications
for human health
Community Resilience and Incident Management
The KDHE Secretary, who serves as the State Health Officer, or his designee, will lead the state
response to pandemic influenza or any other infectious disease emergency in Kansas. Local
health departments are also encouraged to develop and implement a structured parallel system of
pandemic influenza preparedness.
Community Preparedness
The KDHE Secretary has designated a Pandemic Influenza Preparedness Committee (PIPC) to
develop this Kansas Pandemic Influenza Preparedness and Response Plan and to provide
guidance to local health departments regarding local plan development. The members of the
PIPC will advise the KDHE Secretary on issues related to their specific areas of expertise for
implementation of the state’s public health response to pandemic influenza. Members of the
PIPC are listed in Table 1.
Table 1
Pandemic Influenza Preparedness Committee (PIPC) Members
KDHE Secretary/State Health Officer Director, Bureau of Epidemiology and Public
Health Informatics
State Epidemiologist KHEL Health Section Chief
Preparedness Director, Bureau of Community
Health Systems
Director, Kansas Health and Environmental
Laboratories (KHEL)
Director, Bureau of Community Health
Systems
Kansas Medical Countermeasures Program
Coordinator, Bureau of Community Health
Systems
Deputy Preparedness Director, Bureau of
Community Health Systems
Section Chief, Kansas Immunization Program
Senior Director, KDHE Office of Public
Affairs
Surveillance Director, Bureau of
Epidemiology and Public Health Informatics
Director, Bureau of Disease Control and
Prevention
Emergency Management Coordinator, Office
of the Secretary
All of the members of the PIPC are housed within KDHE. Many other subject matter experts
within and outside of KDHE are available to provide advice and support to the PIPC.
The PIPC will review this Kansas Pandemic Influenza Preparedness and Response Plan at least
annually and recommend updates. The BCHS Deputy Preparedness Director will be responsible
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 11
for updating the plan document. Annual plan updates are posted to the KDHE website
(http://www.kdheks.gov/cphp/download/KS_PF_Plan.pdf) each January.
Activities of the PIPC are briefed at the Kansas Commission on Emergency Planning and
Response, which meets quarterly. The Clinical Resource Network, a group of practicing
physicians who are available for consultation during a public health emergency, may also review
the plan and provide feedback as needed. The agencies represented for each of these committees
are listed in Appendix D.
The Kansas Division of Emergency Management (KDEM) is responsible for promulgating
standards for local emergency planning. Staff from KDHE and KDEM collaborated to develop
the standards for Emergency Support Function (ESF) 8 – Health and Medical and for the local
BIA template. Local pandemic influenza response is described in local BIAs. The Kansas
Pandemic Influenza Preparedness and Response Plan is housed within the state BIA as
Attachment 1.
Kansas has a decentralized system of 117 enhanced 9-1-1 centers, which serve as the Public
Safety Answering Points (PSAPs) for Kansas communities. To facilitate local preparedness, the
U.S. Department of Transportation has released the document “Preparing for Pandemic
Influenza: Recommendations for Protocol Development for 9-1-1 Personnel and Public Safety
Answering Points (PSAPs)” which may be accessed at
http://www.nhtsa.gov/people/injury/ems/PandemicInfluenza/. The Kansas Highway Patrol has a
central communication center that conducts activities similar to PSAPs (with respect to
dispatching emergency responders) and may serve as a beneficial guide to local entities.
The Kansas Board of Emergency Medical Services (KBEMS) has written EMS pandemic
influenza operational procedures that define the role of EMS in preparing for, mitigating and
responding to pandemic influenza. This information is available at
http://www.ksbems.org/ems/?page_id=1457 to be a part of the overall all hazards response plan
which forms the basis of the agency’s internal and external operating procedures in a
contingency environment for ensuring Emergency Medical Service systems’ ability to respond to
an emergency. A key mission of the agency is to ensure the provision of expedient, effective and
efficient assessment, treatment, transport and accountability of casualties of natural or manmade
disasters while ensuring employee health and safety.
The State of Kansas continues to build relationships with the private sector, including hospitals,
pharmacies and other industries. Various outreach measures have occurred, including forums
with industry leaders to discuss further cooperation efforts as well as providing pandemic
influenza-specific information for industry on websites. BCHS has updated its website to
include a section specifically targeting business and industry and preparedness efforts at
www.kdheks.gov/cphp/business.htm. KDHE will continue to work with KDEM and the U.S.
Department of Homeland Security Protective Security Advisor to share information relevant to
protecting critical infrastructure, key resources, and industry in general, and to promote
preparedness efforts to increase response cooperation and coordination.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 12
Emergency Operations Coordination
Kansas has adopted the Incident Command System (ICS) and National Incident Management
System (NIMS) for responding to disasters and emergencies (Executive Order 05-03). The
NIMS was published in March 2004 and the Third Edition of the National Response Framework
(NRF) was finalized in July 2016. Local and state agencies have revised plans to include NIMS-
compliant activities and to align with the NRF. This is a challenging process that requires cross-
agency and cross-jurisdictional coordination in order to be successful.
KDHE has established the current system of incident management based on the ICS to organize
the response to public health, medical and environmental emergencies in Kansas. Throughout
this plan, ICS titles are used to identify roles and responsibilities for responding to a pandemic
influenza incident. Day-to-day position titles are used in the preparation phases of the plan to
clearly indicate planning responsibilities.
The KDHE utilizes Incident Activation Levels (IALs) to determine and iterate the proper levels
of activation of the KDHE Department Operations Center (DOC) and ICS. A chart outlining the
IALs is provided in Appendix B. When conditions or criteria suggest a Level 3 activation, which
is not expected to occur in the CDC Investigation or Recognition intervals, KDHE will activate
its ICS. This process will be further described later in this plan. KDHE has developed job action
sheets and training materials for the Command and General Staff roles.
Local health departments are required to maintain and update plans and SOGs regarding
response to emergencies. These plans and SOGs contain specific information regarding mass
vaccination clinic activities, communications, and community disease containment. The local
SOG templates can be found on the KDHE public website:
www.kdheks.gov/cphp/operating_guides.htm.
Components of this plan and the corresponding SOGs will be exercised at least annually.
Evaluations of the exercises will be conducted and improvement plans will be developed in
accordance with the Homeland Security Exercise Evaluation Program
(https://www.fema.gov/hseep). The Public Health and Healthcare Preparedness Capabilities
(http://www.cdc.gov/phpr/capabilities/)
(http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/capabilities.pdf) will be
used to evaluate health and medical aspects of the exercises. The recommended updates will be
made to this plan and the corresponding SOGs upon completion of after-action reviews.
The Kansas Department of Agriculture (KDA) is responsible for food safety regulation in
Kansas, and risk-based inspections are designated as a Priority 1 Essential Service in the KDA
Continuity of Operations (COOP) plan. Staff from a variety of programs outside of food safety
may be utilized to conduct inspections and ensure compliance with federal statutes administered
by the United States Department of Agriculture (USDA), the HHS Food and Drug
Administration (FDA) and KDA.
The point of contact for food safety issues in the event of a pandemic is the Emergency
Management Coordinator, Office of the Secretary, Kansas Department of Agriculture. The
KDA COOP plan includes an influenza pandemic as a possible threat. This plan ensures that
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 13
each position designated as critical will be backed up with at least three trained individuals.
Currently, the KDA Legislative Researcher and the KDA Public Information Officer (PIO) serve
as backup should the KDA Emergency Management Coordinator be unavailable during a food
safety emergency. The KDA also works closely with KDHE Bureau of Epidemiology and
Public Health Informatics (BEPHI). The BEPHI will most likely receive initial notification of
foodborne illness activity and will be a critical component to an effective response to a food
safety emergency during a pandemic or any other time. These responsibilities occur on a day-to-
day basis and are outlined in statute, the Kansas Response Plan, and agency protocols and
procedures.
The KDA COOP plan ensures that two additional personnel are trained and identified for each
position currently charged with essential food safety functions. A just-in-time training program
is under development that can be used if more than twice the number of staff would be needed in
the event of a pandemic.
Food Safety Reporting
In all emergencies in Kansas, local entities report problems and request resources through the
county Emergency Operations Center (EOC). This process would not change in a pandemic.
Issues are first resolved at the local level, and then mutual aid is utilized if available. Problems
and resource requests that cannot be handled at the local level are reported to the Response
Section in the State EOC (SEOC). Issues with food safety specifically will be tasked to the ESF
11 desk.
Strategic Goal – Food Safety
Operating objectives for the Kansas Department of Agriculture:
• Ensure all food producers, transporters, retailers and consumers are aware of information
and educational resources before, during and after a pandemic.
• Assist farm-to-fork operators with planning for the human resource challenges that may
affect their businesses during a pandemic.
• Serve as a source of information for stakeholders regarding state and local actions and
resources available to producers.
• Engage in vigorous continuity of operations planning to ensure that the department can
continue to provide the necessary services in order to maintain the integrity and safety of
the food supply.
The KDA Emergency Management Coordinator serves as the coordinator assigned to prepare the
state to carry out critical agriculture programs (ESF 11). The operating objectives for this goal
are:
• Ensure that the KDA COOP plans are trained and tested on an annual basis.
• Ensure that USDA nutrition assistance programs are identified as priority programs
within each responsible agency.
• Ensure that all COOPs relating to ESF 11 include the identification of backup personnel,
cross-training, checklists and notification rosters.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 14
• Ensure that local units of government, the public and agricultural producers are aware of
assistance that will and will not be available from the state during a pandemic.
Many Kansans depend on nutritional assistance programs. These programs are managed by a
variety of governmental and nongovernmental organizations. In the event of a severe pandemic,
many people may be unable to report to work and this may have a major impact on the ability to
carry out state-administered programs. The KDA Emergency Management Coordinator is
working with the various state program managers to develop and expand on alternate models of
delivering these services. Agency COOP plans are currently in development and these
nutritional assistance programs will be a priority for each agency responsible for implementing
these programs. Local guidance will be developed that describes alternate ways to implement
nutritional assistance at the local level. Waivers and executive orders will be drafted that may be
utilized to streamline some processes in the event of a pandemic.
Nutritional assistance program status will be reported on a weekly basis to the ESF 11 desk in
the SEOC. If there are problems or needs, program managers will also report these to the ESF
11 desk as they occur. In the event of an agriculture emergency, the producers will notify their
local EOC. Animal disease emergencies are reported to the local veterinarian and are reported to
the Animal Health Commissioner based on signs and symptoms. Animal disease incidents will
be also be coordinated through the SEOC; staff from the Division of Animal Health will respond
to support the ESF 11 function. Requests for assistance will be routed to the ESF 11 desk in the
SEOC.
Community Recovery
Agencies of the State of Kansas participate in the Kansas Continuity of Operations (COOP)
Committee. Through this committee, the Kansas Department of Administration has produced
and released a reference guide to provide technical assistance on human resource topics to State
of Kansas executive branch agencies. Executive branch agencies should use the information
contained in the guide during the development of their agency-specific COOP plan to ensure the
continuity of internal critical services should buildings/facilities and support infrastructure (staff,
Information Technology, and business systems) become unusable or unavailable. In the event a
COOP emergency is declared in the State of Kansas, the Office of Personnel Services
representatives for each individual agency will be the central points of contact for state
employees. State agency Office of Personnel Services offices will be required to determine
which workers are essential, how payroll will be processed, what leave options will be granted,
and how various staffing issues will be addressed. The reference guide provides material for
agencies to evaluate against their own current COOP plan. This reference guide provides
direction in the following areas: essential functions and staffing, telecommuting, human resource
policies, and communication with employees.
Community resilience and incident management activities during the Interpandemic Period
include:
• Identifying issues specific to pandemic influenza
• Meeting with the Commission on Emergency Planning and Response and other
emergency planners
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 15
• Ensuring that specific challenges posed by an influenza pandemic are addressed in
hospital response plans
• Reviewing pertinent legal authorities including:
o Isolation and quarantine laws
o Laws and procedures for closing businesses or schools and suspending public
meetings
o Medical volunteer licensure and liability
o Compensation laws for in-state, out-of-state, and returning retired medical and
non-medical volunteers.
• Conducting and participating in exercises with hospitals, local communities, EMS,
industry, volunteer groups, state agencies, federal agencies and private businesses.
• Incorporating lessons learned from exercises into improvement plans that are tracked and
implemented.
Community Resilience and Incident Management – Centers for Disease Control & Prevention
CDC Interval: Investigation
Director of the
Division of Public
Health, Kansas
Department of
Health &
Environment
(KDHE)
Convene state-level task force to review plan and provide input ✓
Provide direction and leadership to KDHE Pandemic Influenza
Planning Committee (PIPC)
✓
Work with KDHE Office of Legal Services to review legal
authorities
✓
Medical
Countermeasures
Coordinator,
KDHE-Bureau of
Community Health
Systems (BCHS)
Identify warehouse space to be used for antiviral and vaccine
storage and distribution
✓
Train and exercise the distribution plans ✓
Operations
Specialist, KDHE-
BCHS
Ensure the KDHE Department Operations Center is functional
✓
Deputy
Preparedness
Director, KDHE-
BCHS
Coordinate distribution of pandemic influenza related planning
information to critical infrastructure with Kansas Division of
Emergency Management (KDEM) and U.S. Department of
Homeland Security (DHS) Protective Security Advisor
✓
Revise this plan on an annual basis (January) ✓
Work with state and local agencies to ensure all are aware of
various roles and responsibilities identified in this plan and the
Kansas Response Plan (KRP)
✓
Immunization
Section Chief,
KDHE-Bureau of
Disease Control &
Liaison for messaging to ensure it is consistent with CDC and
the most recent guidelines associated with immunization
✓
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 16
Prevention
(BDCP)
Influenza
Surveillance
Coordinator,
KDHE-Bureau of
Epidemiology &
Public Health
Informatics
(BEPHI)
Liaison for surveillance data between local, state and federal
partners
✓
Emergency
Management
Director, KDHE-
Office of the
Secretary
Lead the KDHE Continuity of Operations Planning (COOP)
group
✓
Kansas
Department of
Agriculture (KDA)
Ensure all food producers, transporters, retailers and consumers
are aware of information and educational resources before,
during, and after a pandemic
✓
Assist farm-to-fork operators with planning for the human
resource challenges that may affect their businesses during a
pandemic
✓
Serve as a source of information for stakeholders regarding local
and state actions and resources available to producers
✓
Engage in vigorous continuity of operations planning to ensure
that KDA can continue to provide the services necessary to
maintain the integrity and safety of the food supply
✓
Ensure that the KDA COOPs are trained and tested on an annual
basis
✓
Ensure that USDA nutrition assistance programs are identified
as priority programs within each responsible agency
✓
Ensure that all COOPs relating to ESF 11 include the
identification of backup personnel, cross-training, checklists and
notification rosters
✓
Ensure that local units of government, the public and
agricultural producers are aware of what assistance will and will
not be available from the state in a pandemic
✓
All local and state
agencies
Continue continuity of operations planning efforts including
training staff and exercising of COOPs
✓
Kansas Board of
Emergency
Medical Services
(KBEMS)
Develop local EMS planning guidelines and templates ✓
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 17
Biosurveillance
Influenza viruses have constantly changing antigenic properties. Surveillance for pandemic
influenza must include both laboratory surveillance, in which influenza viruses are isolated for
antigenic and genetic analysis, and disease surveillance, in which the epidemiologic features and
clinical impact of new variants are assessed. The goals of influenza surveillance are to detect the
earliest appearance of a novel influenza virus in Kansas and to describe the epidemiologic
features of novel virus circulation.
When a novel influenza A virus is identified in humans but is not circulating widely in the
human population, it is important to evaluate 1) the risk that the virus will develop efficient and
sustained human-to-human transmission and 2) the risk that the virus will substantially affect
public health. The Influenza Risk Assessment Tool (IRAT) was developed to facilitate such an
assessment. IRAT is used by the U.S. government and the World Health Organization (WHO)
Global Influenza Surveillance and Response System as a risk assessment process that involves
data gathering, discussion, and consensus building among subject-matter experts to assign a risk
score. Ten predefined risk elements are given a risk score. These 10 elements fall into three
categories: 1) attributes that pertain to the biologic properties of the virus (four elements), 2)
attributes of the population (three elements), and 3) attributes of the ecology and epidemiology
of the virus (three elements). The results of this assessment can be used to decide whether and
how to act and communicate concerns regarding both emergency and potential public health
impact. As new information becomes available, the scoring can be repeated.
Since most influenza A viruses are avian in origin, it is essential that KDHE work with Kansas
Department of Agriculture and USDA in monitoring circulating animal viruses, especially highly
pathogenic avian influenza. KDA has developed a plan to cull poultry in response to detection
of highly pathogenic avian influenza. Plans include the provision of personal protective
equipment (PPE) and prophylaxis of workers at risk for exposure to the viruses. KDHE will
work with KDA to ensure that workers who have been exposed and become symptomatic are
treated, to decrease the risk of producing a pandemic strain of influenza by re-assortment of
virus.
Public Health Surveillance and Epidemiological Investigation
The BEPHI, in cooperation with the Kansas Health and Environmental Laboratories (KHEL),
maintains Kansas’ involvement in year-round national influenza surveillance coordinated by the
CDC. The BEPHI and KHEL assume primary responsibility for implementing and coordinating
virologic morbidity and mortality surveillance components in Kansas and compliance with future
recommendations for surveillance enhancement. Current national influenza surveillance
activities include:
Virologic surveillance: The Global Influenza Surveillance and Response System (GISRS),
formerly known as the Global Influenza Surveillance Network, was established in 1952 by the
World Health Organization to monitor the evolution of influenza viruses and serves as a global
alert mechanism for the emergence of influenza viruses with the potential to cause pandemics.
Approximately 85 U.S. World Health Organization (WHO) Collaborating Laboratories and 60
National Respiratory and Enteric Virus Surveillance System (NREVSS) laboratories located
throughout the United States participate in virologic surveillance for influenza. All state public
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 18
health laboratories participate as U.S. WHO collaborating laboratories. Each week the WHO
collaborating laboratories report the number of clinical specimens tested for influenza and the
number of positive results by virus type (A or B); most also report influenza A subtype (H1 or
H3). A subset of the influenza viruses collected by U.S. WHO collaborating laboratories are sent
to CDC for further characterization, including gene sequencing, antiviral resistance testing and
antigenic characterization.
Surveillance for influenza-like illness (ILI): The U.S. Outpatient Influenza-like Illness
Surveillance Network (ILINet) consists of more than 2,800 enrolled outpatient healthcare
providers in all 50 states, Puerto Rico, the District of Columbia, and the U.S. Virgin Islands
reporting more than 39 million patient visits each year. The Influenza like Illness Surveillance
Network (ILINet) providers regularly report the number of patient visits for ILI by age group and
the total number of patient visits each week during the normal influenza season. Kansas has 37
ILINet sites. These data are used to calculate and track the percentage of outpatient visits due to
influenza-like illness. In addition, Kansas utilizes the National Syndromic Surveillance Program
(NSSP) to monitor ILI as within the chief complaint data received from participating emergency
departments. Currently, Kansas’ syndromic surveillance system covers approximately 85% of all
emergency departments in the state.
Surveillance for influenza and pneumonia deaths: The percentage of deaths due to pneumonia
and influenza (P&I) are compared with a seasonal baseline and epidemic threshold value
calculated for each week. The updated numbers are posted on the KDHE influenza website
weekly during the regular flu season.
Surveillance for influenza immunization coverage: The Kansas Immunization Program maintains
a birth to death electronic immunization registry (KS-WebIZ). This web-based system tracks
administration of influenza vaccine as well as all other vaccines provided by a network of over
1,000 public and private provider offices statewide. KS-WebIZ holds records for over 2,000,000
individuals for which current immunization status may be accessed to determine community
level immunization coverage rates.
State and territorial epidemiologists assess influenza activity levels each week and report it as
“widespread,” “regional,” “local,” “sporadic,” or “no activity” to the CDC. In addition, CDC
analyzes influenza activity intensity levels and displays this information on their website
geographically.
During the Interpandemic Period, KDHE will maintain Kansas’ current influenza surveillance
activities, which include:
• An ILINet provider program with at least the minimum number of healthcare providers
(1 per 250,000 persons) that report their weekly data to KDHE or directly to CDC via the
Internet year-round. These providers are encouraged to send at least two specimens per
week to KHEL for molecular analysis. This testing is provided at no charge to the patient.
A map of counties with ILINet surveillance sites can be found in Attachment M.
• A disease reporting hotline that is available and is staffed at all times by an
epidemiologist, including nights and weekends at 877-427-7317.
• Information on the Kansas Board of Healing Arts list of physicians.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 19
• The Kansas Health Alert Network system.
• An active State Influenza Surveillance Coordinator in BEPHI who:
o Monitors ILINet provider data weekly for completeness and/or errors.
o Provides feedback and maintains contact with ILINet providers weekly to
encourage reporting and follow-up on unusual reports.
o Contributes to state pandemic planning issues and activities.
o Maintains a strong working relationship with the KHEL.
o Encourages ILINet providers to submit specimens for viral culture to the state
laboratory.
o Conducts a weekly assessment of overall influenza activity level in the state
during the normal flu season and reports the data to the CDC.
Kansas uses WebEOC, a web-based system to manage information. Hospital bed availability
and other emergency related data are collected in EMResource, which can collect the following
statewide data:
• Available (or needed) staffed beds (specifies adult or pediatric):
o ICU/CCU beds
o Medical beds
o Emergency Department (monitored and unmonitored)
• Available number of ventilators
• Available negative-pressure air isolation rooms
• Number of healthcare professionals affected
• Morgue capacity
• Available or needed medical supplies, equipment, and personal isolation equipment
• Number of hospitals on Emergency Department Diversion
• Number of patients waiting for inpatient beds (to include average wait time)
The electronic screens used to collect this data will be based on forms that will be available in
paper format if the Internet-based system fails.
KDHE currently has a secure Web-based death certificate registration system that was enhanced
as of July 2009. It is used by funeral directors and physicians across the state. Funeral directors
enter the demographic information of the deceased. Physicians use the web-based system,
through traditional or mobile devices, to complete the cause of death electronically and apply an
electronic signature. The system will be made available to Infectious Disease Epidemiology and
Response (IDER), the Bureau of Community Health Systems (BCHS), and OVS staff regarding
deaths from specific causes, such as influenza or pneumonia. In the event that the electronic
death reporting system is not operational, influenza-associated deaths will be tabulated manually,
using traditional, paper-based methods.
In the event of a suspect or confirmed case of pathogenic avian influenza, the Kansas Animal
Health Commissioner will contact the State Epidemiologist or designee directly or via the
Epidemiology Hotline, in addition to contacting the Adjutant General’s Department via email.
This connection between the Animal Health Commissioner and KDHE seeks to maintain a
continuous and coordinated connection between animal and human health surveillance systems.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 20
During this period, KDHE, KBEMS and Public Safety Answering Point (PSAP) representatives
will discuss the utility of alerting, as well as any changes in criterion necessary to identify a
specific pathogen, based upon patient care data for pandemic influenza surveillance. Utilizing
the Kansas EMS Information System (KEMSIS), KBEMS has a method to monitor and detect
not only patients with influenza-like illness, as defined by the CDC, but also has the ability to
monitor and alert upon any specific criterion that may be present for any type of pandemic
situation utilizing prehospital care data.
Improved situational awareness through information sharing regarding both patients and
resources will enable better management of assets during a pandemic and provide for real time
epidemiological analysis. KDHE will utilize the Kansas Health Alert Network (KS-HAN) to
communicate relevant pandemic influenza information to health and medical providers. The
need for a statewide patient tracking system continues to be demonstrated through many
emergency incidents. KDHE continues to work on a patient tracking system that can be utilized
at all levels of the medical system to track an individual from first contact with professional
medical care through eventual dismissal from care. As part of this effort and as identified in the
2009 Kansas Homeland Security Strategy, KDHE has formed a multi-disciplinary, multi-agency
work group to develop a statewide patient tracking system and recommend minimum
requirements for electronic applications to support that statewide system.
KEMSIS has been operational since 2008 and contains nearly real-time patient care data from
approximately 90% of the ambulance services within Kansas. Information within this system
can be used for patient care report generation, individual system analysis and monitoring of
injuries, patient dispositions, and patient transfer patterns.
Public Health Laboratory Testing
The Kansas Health and Environmental Laboratories (KHEL) play a pivotal role in the detection
and identification of influenza viruses. To promote a complete influenza surveillance system,
KDHE will maintain:
• A state public health laboratory that:
o Continues to perform real time polymerase chain reaction RT-PCR analysis while
providing guidance and interpretation on the increasing use of rapid influenza
diagnostic tests in private and public healthcare settings.
o Detects and subtypes influenza viruses during the influenza season.
o Maintains the capability to detect and sub-type influenza viruses year-round and
submits specimens to CDC for antiviral resistance analysis.
o Transmits influenza data (positives and negatives) electronically to CDC via the
CDC/WHO Influenza Surveillance System Reporting website (a secured site).
o Provides regular updates on respiratory specimen testing status to the Influenza
Coordinator throughout the influenza season.
o Conducts RT-PCR testing for novel subtypes of influenza viruses within
Biosafety Level 2 (BSL-2) conditions.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 21
o Ensures prompt reporting of unusual or novel influenza specimens to in order to
facilitate control and management of local outbreaks contact:
▪ BEPHI, via Epidemiology Hotline (877-427-7317).
▪ LRN Results Messenger for confirmed A/H5 strain.
▪ CDC/WHO Influenza Surveillance System Reporting website.
o Submits increased numbers of influenza specimens from positive patients as
requested to CDC for enhanced monitoring for antiviral resistance.
o Is actively involved in contingency planning for surge capacity (staffing and
reporting) and safety issues.
▪ Implements enhanced cross-training of existing laboratory staff in RT-
PCR methods.
▪ Educates clinical laboratorians on the safety and handling of specimens
suspected to contain novel influenza viruses.
▪ Institutes an influenza vaccination policy for influenza-like illness among
laboratory personnel.
To protect the health of laboratory workers during a pandemic, public health, clinical, and
hospital laboratories should maintain enhanced safety practices. These include:
• Conducting laboratory procedures under appropriate biocontainment conditions.
o Commercial antigen detection testing for influenza should be conducted using
BioSafety Level 2 (BSL-2) work practices.
o If new or re-emergent human influenza strains with pandemic potential are
suspected, laboratories should establish separate BSL-2 containment conditions
utilizing BioSafety Level 3 (BSL-3) components, such as enhanced personal
protective equipment as recommended by CDC, before RT-PCR testing.
▪ As a consequence of the danger that highly pathogenic avian influenza
(HPAI) strains present to the U.S. agricultural industry, USDA regulations
require that HPAI strains such as H5N1 (which are classified as select
agents) must be cultured using BSL-3 biocontainment conditions with
enhancements.
• Strongly encouraging routine vaccination of all eligible laboratory personnel who are
exposed to specimens from patients with respiratory infections.
• Staffing and training laboratories for increased staffing needs.
o Cross-training personnel during the regular influenza season in the use of rapid
diagnostic tests and RT-PCR protocols and in reporting results through existing
surveillance systems.
o Recruiting and training temporary staff for employment during a pandemic.
• Supplies and equipment.
o Laboratories are likely to require additional diagnostic supplies and equipment to
process large numbers of samples during the initial stages of a pandemic. Some
preparedness strategies include:
▪ Establishing the current level of diagnostic supplies, including personal
protective equipment for laboratorians (e.g., gloves, lab coats).
▪ Assessing anticipated equipment and supply needs, and determining a
trigger point for ordering extra resources.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 22
• Specimen management.
o State and local health departments should inform and educate public health staff
(including laboratorians), local physicians, and hospital workers on safe and
effective methods for specimen collection and management, making use of the
guidelines detailed on KHEL’s website, packaging and shipping section, under
virus shipper guide (www.kdheks.gov/labs/packaging_and_shipping.html).
o Procedures for specimen collection, handling, and shipping during a pandemic
will be the same as those used for seasonal disease surveillance. However,
laboratory staff should anticipate shipping of much larger numbers of specimens
in a very short time, especially during the early stages of a pandemic.
Biosurveillance – Centers for Disease Control & Prevention (CDC) Interval: Investigation
Influenza
Surveillance
Coordinator,
KDHE-Bureau of
Epidemiology &
Public Health
Informatics (BEPHI)
Maintain the ILINet surveillance program with providers ✓
Maintain a strong working relationship with the Kansas Health
and Environmental Laboratories (KHEL)
✓
Participate in CDC training regarding surveillance and adverse
events reporting
✓
Planning &
Outreach Specialist,
KDHE-Bureau of
Community Health
Systems (BCHS)
Work with EMResource to improve Hospital Availably Beds for
Emergency Disasters (HAvBED) and other tools to promote
situational awareness
✓
KDHE-KHEL Continue to isolate and sub-type influenza viruses year round
including reporting during influenza season to CDC
✓
Kansas Board of
Emergency Medical
Services (KBEMS)
Continue development of the statewide patient care report
system for use by local EMS agencies
✓
Surveillance
Coordinator,
KDHE-BEPHI
Development of a secure system for managing and collecting
patient and system data
✓
Development of a just-in-time training for use of surveillance
system and associated tools
✓
Surge Management
Emergency response, including maintenance of critical services and surge capacity issues in the
healthcare system, is addressed in the state, local, and medical facility response plans and SOGs.
Medical Surge
There are 127 community hospitals in Kansas and the staffed beds in these facilities range from
10 to 1,451. The average daily census indicates there are approximately 1,000 available beds in
Kansas on any given day. It is estimated during a pandemic influenza event; approximately
5,000 to 10,000 beds would be needed to provide care for influenza patients.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 23
Hospitals in Kansas use a regional planning process to prepare for an increase in acutely ill
patients. The state is divided into seven regions and each region has designated a regional
planning hospital. The regional plans for increasing available bed capacity at each hospital to
accommodate a regional surge of 500 acutely ill infectious patients per 1 million population over
a short period of time may consider the following approaches:
• Hospitals will cancel non-emergency surgeries and other elective procedures.
• Hospitals will discharge non-infected patients to other acute care facilities out of the
affected geographical area, or to long-term care or home care while assuring that the level
of care required by these patients can be met.
• Hospitals will transfer patients to other hospitals in the region with available beds.
Hospitals may need to send patients to several other hospitals depending on bed
availability. Hospitals will start by transferring patients to hospitals in nearby counties,
then to other hospitals in the region.
• If all hospital beds in the region are at capacity, then hospitals will transfer patients to
hospitals in other regions.
• Finally, if hospitals in other regions are full, the hospital will send patients to alternate
locations based upon their partnerships (long term care facilities, schools, etc.).
Hospital and county emergency planners have identified and continue to identify alternate care
sites. KDHE BCHS has developed a template alternate care site plan that may be utilized to
assist community planners. The template plan is located at
http://www.kdheks.gov/cphp/operating_guides.htm. For an alternate care site to be successful,
the entire community and all agencies must work together bringing their own strengths and
available resources to bear. Alternate care sites will likely be considered the option of last resort,
so all health and medical partners in the community should be engaged in pre-pandemic
planning. For example, home healthcare agencies will likely play an important role, given the
potentially high number of ill persons. In addition, during a severe pandemic it is expected
family members will likely need to provide care to family members who are unable to be
hospitalized. Instructions for home (family) care can be found in Appendix F. Healthcare and
hospital personnel will also need to stay informed related to the best practices for infection
control for pandemic influenza from the CDC. Those guides may be located
http://www.cdc.gov/flu/pandemic/healthprofessional.htm.
Since 2009, KDHE has considered the possibility that additional medical guidelines may be
needed to provide recommendations to physicians, hospitals and communities to increase
medical surge during a public health emergency. In May of 2013, an analysis of various reports
from across the United States and previous work of the Kansas Health Institute was conducted
by the KDHE Clinical Resource Network. This work produced “Guidelines for the Use of
Modified Health Care Protocols in Acute Care Hospitals During Public Health Emergencies”
which describe principles and practices health care providers, acute care hospitals, and
communities can utilize for planning for the provision of care in the event resources become
scarce during a disaster. These guidelines have been shared with hospitals and communities
throughout Kansas for incorporation into facility and community specific medical surge plans
which would likely be considered during a pandemic influenza.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 24
In planning for an influenza pandemic, it must be recognized persons with medical conditions
unrelated to influenza will continue to require emergency, acute and chronic care. Alterations to
an EMS system’s practices during an influenza pandemic will likely impact all EMS patients,
regardless of the nature of their illness. Planners should consider modifying PSAP call-taker and
dispatch protocols and developing pandemic-specific pre-hospital triage and treatment protocols.
It is important to keep the EMS system functioning as effectively as possible and to deliver
optimal care to both these patients (e.g. motor vehicle crashes and cardiac events) as well as to
patients with influenza related symptoms. Illness and absenteeism during a pandemic may
impact an EMS agency’s ability to satisfy demand for services.
The most serious challenge the medical system (including hospitals and EMS) will likely face
during an influenza pandemic is to keep operations functioning despite increases in call volume,
workforce shortages and absenteeism, supply chain disruptions and other threats to continued
operations. The foundation of a viable COOP program is the development and documentation of
a COOP plan that provides for the continued performance of an organization’s essential functions
under all circumstances. Agencies should continue to develop, refine and test their COOP plans
based on guidance from federal, state and local government. COOP plans should be coordinated
with emergency management agencies. Pre-established delegations of authority are vital to
ensuring all organizational personnel know who has the authority to make key decisions in a
COOP situation. An order of succession is essential to an organization’s COOP. Personnel
should know who has authority and responsibility if the leadership is incapacitated or
unavailable. COOP plans should address workforce health protection. Health agencies should
establish policies for flexible worksite (e.g. telecommuting) and flexible work hours (e.g.
staggered shifts) whenever possible. Agencies should establish policies for employee
compensation and sick-leave absences unique to a pandemic (e.g. non-punitive liberal leave).
Volunteer Management
Healthcare and pre-hospital systems should consider a variety of mechanisms to augment their
workforce including:
• Communications with licensing agencies to explore mechanisms for temporary licensure
of medical or EMS providers from other jurisdictions
• Communications with licensing agencies to explore innovative mechanisms to rapidly
recruit, train and license new providers
• Consider non-traditional system configurations and alternate staffing configurations
• Utilization of retired EMS and healthcare personnel
• Coordination with local Medical Reserve Corps (MRC)
• Community Emergency Response Teams (CERT), or cross staffing between EMS,
healthcare and other sectors
• Proactively determine competencies and bridge courses from other professions and levels
of EMS licensure
• Engaging temporary workers, contractors, qualified veterans and recent retirees, and/or
cross-training the existing workforce
• Support telecommuting and telemedicine when feasible.
Surge Management – Centers for Disease Control & Prevention (CDC) Interval: Investigation
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 25
Director of the
Division of Public
Health, KDHE
Continue to engage physicians and healthcare providers in the
planning and preparedness process
✓
Convene workgroups to make recommendations regarding
prioritization of scarce medical resources
✓
Kansas hospitals
Continue to update individual hospital plans regarding medical
surge, evacuation, transport and isolation precautions
✓
Update EMResource daily with bed information, participate in
Kansas Hospital Bed Availability (HAvBED) system drills and
exercises
✓
Identify and coordinate planning with community partners of
alternate care sites that may be used in the event of a pandemic
✓
Review and incorporate the “Guidelines for the Use of Modified
Health Care Protocols in Acute Care Hospitals During Public
Health Emergencies” into facility and community medical surge
plans
✓
Medical
Countermeasures
Program Manager,
KDHE-Bureau of
Community Health
Systems (BCHS)
Ensure state antiviral cache is stored in accordance with
manufacturers’ recommendations
✓
✓
All healthcare and
pre-hospital agencies
Develop and test Continuity of Operations (COOP) plans and
procedures
✓
Information Management
In an emergency, accurate, consistent and timely messages are key in notifying and educating the
public, notifying and facilitating movement of emergency staff to their assigned duties and
stations, and in activating the emergency plan as intended. The following delineates
communication-related issues that pertain to pandemic influenza. Assuring adequate
communication systems will be a joint responsibility of federal, state and local agencies.
• During a pandemic, the public will likely encounter some unreliable and possibly false
information in the media and on the Internet. KDHE and local health departments will
communicate accurate, reliable information regarding the influenza pandemic.
• Mechanisms for communication with the public will vary depending on the phase of the
pandemic and its impact on Kansas communities.
• KDHE will continually strive to communicate with all essential partners.
Emergency Public Information and Warning
CDC will make a number of materials available before and during an influenza pandemic,
including:
• Basic communication materials (such as question and answer sheets and fact sheets) on
influenza, influenza vaccine, antiviral medication and other relevant topics in various
languages.
• General preventive measures such as “dos and don’ts” for the general public.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 26
• Information and guidelines for healthcare providers.
• Training modules (web-based, printed and video).
• Presentations, slide sets, videos and documentaries.
• Symposia on surveillance, treatment and prophylaxis.
Due to anticipated shortages of vaccine and antiviral medication, messages to inform the
population about availability, the rationale for priority groups and measures to be taken will be
critical. Other important topics include:
• Basic information about influenza (including prevention, symptoms and transmission).
• Information about the course of the pandemic (contagiousness, geographic spread,
confirmed and estimated case counts and deaths).
• Information about which symptoms should prompt seeking medical attention and which
symptoms should be managed at home.
• Information about the availability and proper use of vaccines and antiviral medications.
• Information about school and business closures and suspended public meetings.
• Information about travel restrictions as well as isolation and quarantine laws.
Information Sharing
The KDHE Director of the Division of Public Health, or representative, participates on the
Kansas Commission on Emergency Planning and Response (CEPR) which serves as the state
emergency planning committee. This committee consists of representatives from various state
departments, disabled populations, Tribal Nations, hospitals, local health departments, local law
enforcement, local emergency medical services, local fire, cities and counties. A list of
represented disciplines and organizations is located in Appendix D. Pandemic influenza and
general influenza planning activities, including this plan, are briefed to the CEPR annually.
The Kansas Department of Agriculture (KDA) is a regulatory agency mandated by law to ensure
a safe food supply, responsible and judicious use of pesticides and nutrients, the protection of
Kansas’ natural and cultivated plants, integrity of weighing and measuring devices in commerce,
and that the state’s waters are put to beneficial use. Communication with all of the regulated
entities occurs on a regular basis. Regulated entities include: meat and poultry processors,
grocery and convenience stores, restaurants, food manufacturers, food wholesalers, lodging
facilities, wineries, bottlers, dairies, milk haulers, fuel stations, grain elevators, pesticide and
fertilizer products, pesticide applicators, feed manufacturers, seed dealers, nurseries, feedlots,
and plant wholesalers and retailers. The department is also responsible for managing the state’s
water resources and for regulating manmade activities that impact the flow of rivers and streams.
In the event of a pandemic, KDA will share information provided by KDHE with all appropriate
stakeholders. The process for reporting status of facilities and resource requests will be clearly
communicated to stakeholders during all phases of the pandemic. KDA also coordinates with
the Kansas Department of Wildlife, Parks and Tourism (KDWPT) regarding animal health
(domestic and wild).
The Kansas State Department of Education (KSDE) communicates with local educational
agencies in the event of an emergency using the KSDE website, email listservs, automated phone
trees, fax, print media and commercial broadcasts. This communication takes place primarily
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 27
with public schools and school districts, though some private schools can be contacted through
the automated phone tree and listservs. KSDE’s Communications & Recognition Team handles
message creation and distribution, ensuring consistency and quality control of messages. The
Director of KSDE’s Communications & Recognition Team is the state-level education
spokesperson for media relations and communication with local educational agencies.
KDHE will:
• Maintain KS-HAN to effectively communicate with public health officials, healthcare
professionals and other target audiences.
• Establish lines of communication and define KDHE staff roles and responsibilities
clearly to facilitate the best possible communication with partners.
• Regularly distribute informational updates to all appropriate partners.
• In collaboration with state-level partners, provide community mitigation guidance to
facilities such as daycares, K-12 schools, colleges, universities, long-term care facilities
and correctional institutions.
• Maintain the list of media spokespersons and contact information from each state agency.
• Coordinate with KDEM to provide information to the media via the state JIC when
activated.
• Develop an operational plan to distribute communications and educational messages to
the public.
• Educate public health officials, elected officials and the media about what information
will and will not be available during a pandemic.
• Review CDC materials and adapt and revise as needed.
Information Management – Centers for Disease Control & Prevention (CDC) Interval:
Investigation
Director of the
Division of Public
Health, KDHE
Review materials developed by staff to ensure medical accuracy ✓
Provide informational presentations to stakeholders ✓
Director of
Communications,
KDHE
Develop educational materials to be distributed in later stages.
Materials may include: (1) Family (Home) care of symptomatic
individuals, when to go to the hospital, infection control in the
home, when to call the hotline (2) Information for businesses:
Social distancing recommendations in the workplace, how to
manage increased absenteeism. (3) Information regarding
handling of human remains, hotline numbers, process for burial,
death certificates, what to expect
✓
Provide training and resources to local health and medical staff
who may be called to speak to the media during a pandemic
✓
Monitor the KDHE website to ensure preparedness and
influenza information is up-to-date and accurate
✓
Prepare message maps for anticipated questions ✓
Continue to update the KDHE Public Information and
Communication (PIC) Plan
✓
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 28
Establish a mechanism to activate KDHE phone bank
capabilities during a pandemic response
✓
In conjunction with the Bureau of Community Health Systems
(BCHS) Exercise Coordinator, develop just-in-time training for
KDHE phone bank operators
✓
Kansas Health Alert
Network (KS-HAN)
Administrator,
KDHE-Bureau of
Community Health
Systems (BCHS)
Assist KDHE Director of Communications with development
and implementation of systems to facilitate communications
with the public and key stakeholders
✓
Conduct monthly tests of KS-HAN ✓
Exercise
Coordinator, KDHE-
BCHS
Develop and conduct exercises to test the state’s ability to use
the systems developed to enhance communications. Monitor
progress on improvement plans and retest capabilities and tasks
that are not completed to standard
✓
Operations staff,
KDHE-BCHS
Work with the BCHS Exercise Coordinator to implement
actions identified in improvement plans as a result of exercise
activities
✓
Kansas Department
of Agriculture
(KDA)
Maintain communication avenues with regulated entities for the
provision of emergency information
✓
Kansas State
Department of
Education (KSDE)
Maintain communication systems with school districts and
private schools
✓
Communications &
Recognition Team,
KSDE
Prepare message maps for anticipated questions regarding
school dismissal and other pandemic influenza educational
system related questions
✓
Countermeasures and Mitigation
There are three actions that can be taken to prevent and contain outbreaks of pandemic influenza:
non-pharmaceutical interventions (NPI), use of antiviral medication, and vaccination.
Medical Countermeasure Dispensing
During the initial months of an influenza pandemic, no vaccine will be available because it is not
possible to produce a vaccine without knowing the characteristics of the novel virus. Unlike
annual production of influenza vaccine, wherein strains are selected in the spring leading to
vaccine distribution in the late summer, a pandemic strain could be detected at any time. Current
manufacturing procedures require at least 6-8 months before large amounts of vaccine are
available for distribution. Nevertheless, vaccine administration will likely become an important
preventive strategy during the next influenza pandemic, once an effective vaccine is developed.
Contrasts between delivery of pandemic vaccine and the annual influenza vaccine include the
following:
• The target population will be modified, possibly to include sub-populations most likely to
acquire or transmit influenza or most likely to develop complications.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 29
• Demand for the vaccine will be greater than the supply early in the course of the
pandemic due to the minimum 6-8 month period to produce a vaccine; it is also possible
no vaccine will be available. It is impossible to predict how quickly the novel virus would
arrive in the U.S.
• The pandemic vaccine will need to be distributed as quickly as possible once available.
• The emergence of a pandemic strain with new hemagglutinin and or neuraminidase
antigens will likely require a second (booster) dose of vaccine to be administered 2-4
weeks after the first dose is given; since immunologic responses following initial
vaccination of serologically negative individuals is poor and represents a priming of the
immune system.
A final decision regarding the degree of federal vaccine purchase during a pandemic may not be
made until the pandemic vaccine is being produced. Kansas’ plan for delivery and administration
of vaccine addresses many possible scenarios, including complete federal purchase and
distribution to states, partial federal purchase with distribution to states, and minimal federal
purchase (similar to the current annual influenza vaccination program). Currently influenza
vaccine is primarily administered through the private sector. Coordination with and education of
the private sector is a key aspect of local and state-level pandemic influenza planning. During
the 2009-2010 H1N1 pandemic, KDHE utilized a public-private partnership model for vaccine
administration. Through this partnership, KDHE served as the centralized vaccine ordering point
for all pandemic H1N1 vaccine. Private providers registered via a KDHE website to indicate
their interest in providing vaccine. Those interested parties were then vetted by their local health
department and entered into the system. To order vaccine, those private providers would submit
an order through the local health department that would prioritize, validate and approve the
order. All county orders were then submitted by KDHE utilizing the normal business
mechanisms of CDC for the vaccine program. Vaccine was then delivered to and administered
by the private provider who then reported the doses administered using the Kansas
Countermeasures Response Administration (KS-CRA) system. This system maximized the
normal business practices of many entities and proved to be relatively easy to use. This, or a
similar model, may be utilized during the next pandemic.
Recently, the CDC has implemented a new deployment strategy for influenza pandemics.
According to the guidance the CDC will deploy medical countermeasures to all jurisdictions.
This deployment will be completed by using a population-based distribution plan which will
push the medical countermeasures to the jurisdictions rather than states making individual
requests. As part of the Strategic National Stockpile Managed Inventory, the CDC maintains
medical countermeasures to deploy to the states, including: antiviral drugs, PPE (including face
shields, gloves and gowns) and respiratory protection devices (RDP). The SNS will deploy the
jurisdiction’s allocated medical countermeasures in three parts: parts 1 and 2 will take
approximately 7 days for each delivery and part 3 will take approximately 14 days for delivery,
see table 1.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 30
Part 1
~7 Days for Delivery
Part 2
~7 Days for Delivery
Part 3
~14 Days for Delivery
25 % Antiviral Drugs 25% Antiviral Drugs 50% Antiviral Drugs
25% PPE 25% PPE 50% PPE
25% RPD 25% RPD 50% RPD
25% Antimicrobials 25% Antimicrobials 50% Antimicrobials Table 1. Division of Strategic National Stockpile Influenza Pandemic Asset Deployment Strategy. Describes the
amount of allotted medical countermeasures deployed by the SNS in each part.
Due to a relative shortage of vaccine expected early in the pandemic, vaccine recipients will be
prioritized. Recommendations for priority groups will be made at the national level, which will
be adapted by KDHE. The CDC released guidance on allocating and targeting of pandemic
influenza vaccine in July 2008. The Federal Vaccine Priority Recommendations are provided as
Appendix H.
Eventually, it is assumed sufficient vaccine will be available for mass vaccination of the total
population. Local health departments have conducted detailed planning activities culminating in
the creation of the local mass dispensing SOG. This guide explains the specific operations of
large-scale clinic management and how to develop various functions of mass dispensing related
to smallpox, chemo-prophylaxis, and influenza vaccination clinics.
KDHE is upgrading its immunization registration, inventory management and smallpox
vaccination reporting infrastructures. KDHE will utilize the Vaccine Adverse Event Reporting
System (VAERS) to monitor adverse events related to the pandemic influenza vaccine.
An influenza pandemic may pose significant threats to the human infrastructure responsible for
critical community services due to widespread absenteeism and exhaustion in the workforce.
Examples include highly specialized workers in the public safety, utility, transportation and food
service industries, and will likely vary from jurisdiction to jurisdiction. The CDC has issued
guidelines recommending certain priority groups to receive vaccine and antiviral medication.
The CDC priority group recommendations can be found in Appendix H. Based on the severity,
target population, Advisory Committee on Immunization Practices (ACIP) recommendations and
availability of vaccine it is anticipated the vaccine will be targeted to those at higher risk of
severe morbidity or mortality issues irrespective of employment. However, some planning
scenarios have a mixture of prioritization groups that include employment classes and medically
at-risk criteria.
The success of the pandemic influenza vaccination program will be determined in large part by
the strength of local and state vaccination programs during the Interpandemic Period for three
main reasons: (1) increased acceptance of and public confidence in the vaccine; (2) stimulation
of vaccine production by manufacturers to meet demand; and (3) strengthening of distribution
channels.
During the Interpandemic Period, efforts to increase pneumococcal polysaccharide vaccination
(which can reduce the incidence of invasive pneumococcal disease secondary to influenza) is
recommended and emphasized. Since large-scale pneumococcal vaccination may not be feasible
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 31
once a pandemic alert has occurred, the Interpandemic Period is the ideal time to deliver this
preventive measure.
Medical Materiel Management and Distribution
Vaccine will not be available when the novel influenza virus first affects communities.
Therefore, the role of antiviral medications becomes especially significant during this period for
the control of influenza. Existing production capacity for influenza antiviral medication is less
than would be needed to provide prophylaxis or treatment for the entire population. Current
federal guidance requires antiviral medications in this program are to be used for treatment only.
During a novel influenza outbreak, there may be a need for special legal or regulatory
mechanisms for the emergency use of medical countermeasures, including vaccines and
antivirals. Special legal protections under the Public Readiness Emergency Preparedness (PREP)
Act allows for the use of medical countermeasures in an otherwise unapproved way during a
public health emergency. The 2013 enactment of Pandemic All Hazards Preparedness
Reauthorization Act (PAHPRA) enhanced the FDA’s statutory authority of their process to issue
Emergency Use Authorization (EUA) and to expanded access to investigational drugs devices
including investigational new drug application (IND) and investigation device exemption (IDE).
Typically, therapy is effective at decreasing severe complications and reducing hospitalizations
only if offered within two days of developing symptoms. Distribution of antiviral medications
for therapy will be challenging, given the limited amount available, the large number of points of
care and the need to initiate the course of treatment within 48 hours of onset of symptoms in
order for the medications to be effective.
Antiviral medication from the SNS will be distributed to points of care utilizing the distribution
system that is detailed in the Kansas SNS Plan. The KDHE Director of the Division of Public
Health will determine whether controls for dispensing (such as positive rapid test) will be
required. He or she will also provide guidelines on appropriate use of antiviral medications that
are distributed. Antiviral resistance characteristics of the pandemic influenza virus strain will be
a major factor in such determinations. Public education will be very important given the scarcity
of this resource.
Prioritizing within priority groups will be necessary given the limited supply. For antiviral
medication purchased with public funds, the state will be responsible for local distribution of the
antiviral medication in collaboration with the private sector. As with vaccine, it will be critical to
clearly communicate with the public about the rationale for priority groups. Coordination with
and education of the private sector is a key component of the plan. The Kansas Countermeasure
Response Administration (KS-CRA) system will be utilized by all providers who dispense state
or federal antiviral medication resources. Tracking activity in KS-CRA may vary depending on
provider type, but a thorough accounting of all medication doses from state and federal caches
will be required. During the Interpandemic period, KDHE will continue to develop the KS-CRA
system. Additional information regarding KS-CRA may be found at
http://www.kdheks.gov/it_systems/index.htm.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 32
Non-Pharmaceutical Interventions
The CDC has recommended an early, targeted, layered use of non-pharmaceutical interventions
as a key strategy to mitigate the effects of a pandemic on a community. The guidance document
can be found on the www.flu.gov website. KDHE staff prepared a guidance document for local
community planners called the Community Disease Containment Standard Operating Guide
which was provided in 2014. This guidance document is located at
http://www.kdheks.gov/cphp/operating_guides.htm. The interventions recommended by the
CDC are:
• Isolation and treatment (as appropriate) with antiviral medication of all persons with
confirmed or probable pandemic influenza
• Voluntary home quarantine of members of households with confirmed or probable
influenza cases
• Pre-emptive, coordinated school dismissals during a severe influenza pandemic
o Guide to Community Preventive Services. Emergency preparedness and response:
school dismissals to reduce transmission of pandemic influenza.
www.thecommunityguide.org/emergencypreparedness/schooldismissals.html.
Last updated: 08/2012.
o Kansas recognizes that there are challenges implementing this strategy and the
potential benefits and consequences will need to be carefully considered.
• Use of social distancing measures in the workplace and in the community
Kansas planners recognize community containment measures must be implemented at the local
level. Local health department personnel worked with their community partners to develop
guides and processes specific to their communities. These SOGs were exercised in 2006 and
communities are now in the process of refining their plans and procedures based on improvement
plans written as a part of the exercise evaluation process. This comprehensive community
mitigation strategy is intended to slow the spread of pandemic influenza, ultimately saving lives
and reducing demand on healthcare resources, including EMS.
KDHE has worked closely with the Kansas State Department of Education (KSDE) and the
Kansas Association of School Boards (KASB) to develop a Pandemic Action Kit for local school
districts. The kit contains sample parent letters, checklists for schools, media material, fact
sheets, guidance documents, and other useful materials.
KSDE anticipates families will need to focus on basic, immediate physical and emotional needs
during times of crisis, rather than on educational needs. Once a decision is made to dismiss a
school, recommended actions for school districts to take might include:
1. Students should take library books, textbooks, journals, content notebooks, etc., for use
during the time of a school closing.
2. Distributing course materials via the Internet is an option for an extended period of time.
Each district could post items in the content areas by grade level on their website. KSDE
resources could also be accessed at www.ksde.org. During a time of extended school
closing, areas may be operating with limited availability of many things. Educational
content could be made available through the state website and/or respective district
websites.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 33
Responder Safety and Health
Health and medical sector organizations will maintain appropriate respiratory protection
programs in an effort to protect employees from infectious diseases. Organizations will continue
to maintain appropriate stocks of respiratory and other infection control equipment. Appropriate
training, fit testing and vaccinations should be provided to employees to promote a ready
workforce.
Countermeasures and Mitigation – Centers for Disease Control & Prevention (CDC) Interval:
Investigation
Director of the
Division of Public
Health, KDHE
Lead work group efforts to define and recommend containment
activities to local communities
✓
Promote influenza vaccination in traditional high-risk groups,
especially subgroups in which coverage levels are historically
low (e.g. minorities and persons younger than 65 years of age
with chronic underlying medical conditions). Increasing routine,
annual vaccination coverage levels in these groups will further
reduce the annual toll of influenza and will facilitate access to
these populations when the pandemic occurs
✓
Promote pneumococcal vaccination in traditional high-risk
groups to reduce the incidence and severity of secondary
bacterial pneumonia
✓
Medical
Countermeasures
Coordinator, KDHE-
Bureau of
Community Health
Systems (BCHS)
Ensure vaccine distribution plans are coordinated with the
bordering states of Missouri, Nebraska, Colorado, and
Oklahoma, as well as the Kansas City Metropolitan Statistical
Area
✓
Continue to review, modify and exercise the SNS Standard
Operating Guides (SOGs) at the state level and Mass Dispensing
SOGs at the local level
✓
Ensure contingency plans have been considered for emergency
distribution of unlicensed vaccines using emergency
Investigational New Drug Application (IND) provisions
✓
Train and exercise state and community partners on the antiviral
distribution plan
✓
Attorney, KDHE
Review and provide counsel regarding application of state laws
for vaccination planning
✓
Immunization
Section Chief,
KDHE
Maintain the Kansas Immunization Registry to track vaccine and
facilitate reminder notification to track the administration of two
doses per person (if recommended)
✓
Educate the medical community and the public regarding
appropriate vaccine information during a pandemic event
✓
Use VAERS to track adverse events ✓
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 34
World Health
Organization (WHO)
Phases
Centers for Disease Control & Prevention (CDC) Intervals
Alert
Phase
Influenza caused by
a new subtype has
been identified in
humans
Investigation: Investigation of
novel influenza A infection in
humans or animals
Identification of novel influenza A infection in
humans or animals anywhere in the world with
potential implications for human health Recognition: Recognition of
increased potential for ongoing
transmission of a novel
influenza A virus
Increasing number of human cases or clusters of
novel influenza A infection anywhere in the world
with virus characteristics, indicating increased
potential for ongoing human-to-human transmission
During WHO Alert Phase, the U.S. Government may be at the Investigation or the Recognition
Interval. The assumption for the actions detailed below is that the federal government has
moved into the Investigation or Recognition Interval.
Community Resilience and Incident Management
The KDHE Director of the Division of Public Health will meet with the PIPC to review major
elements of the plan and assess and evaluate state and local levels of preparedness. Changes to
the plan will be made as needed. Communication with the border states of Missouri, Oklahoma,
Colorado, and Nebraska, as well as the Kansas City Metro Area, should be maintained. Internal
operating guides will be continually reviewed and updated to ensure staff members are available
and contact information is current.
Community Preparedness
According to the “Implementation Plan for the National Strategy for Pandemic Influenza,” the
federal government will be utilizing the National Response Framework as the primary
mechanism for coordinating the federal response to a pandemic. Roles of key federal agencies
are described in the implementation plan; the roles of the U.S. Department of Health and Human
Services (HHS) and U.S. Department of Homeland Security (DHS) are repeated here.
The U.S. Secretary of Health and Human Services will be responsible for the overall
coordination of the public health and medical response during a pandemic, to include
coordination of all federal medical support to communities; provision of guidance on infection
control and treatment strategies to local, state and tribal entities, and the public; maintenance
prioritization, and distribution of countermeasures from the SNS; ongoing epidemiologic
assessment, modeling of the outbreak, and research into the influenza virus, novel
countermeasures, and rapid diagnostics.
The U.S. Secretary of Homeland Security will be responsible for coordination of the federal
response as provided by the National Strategy for Pandemic Influenza Implementation Plan the
Homeland Security Act of 2002, and Homeland Security Presidential Directive #5, and will
support the Secretary of Health and Human Services’ coordination of overall public health and
medical emergency response efforts. The Secretary of Homeland Security will be responsible
for coordination of the overall response to the pandemic, implementation of the policies that
facilitate compliance with recommended social distancing measures, the provision of a common
operating picture for all departments and agencies of the federal government, and ensuring the
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 35
integrity of the nation’s infrastructure, domestic security, and entry and exit screening for
influenza at the borders.
Emergency Operations Coordination
KDHE will initiate ICS at Level 2 – Watch in preparation for pandemic influenza response.
When this occurs, Operations and Logistics Section staff will begin activities to verify facilities
identified in this plan are ready to start response operations. Finance and Administration staff
will prepare to begin documenting expenses related to pandemic response. Notification of a
possible biological emergency will be communicated to KDEM and a Liaison Officer will be
requested.
The KDHE Incident Commander will convene the PIPC and review the plan and corresponding
SOGs.
• Initiate KDHE Emergency Operations Guidelines (EOG).
• Maintain ILI disease surveillance.
• Activate the Public Information and Communication (PIC) Plan.
• Begin vaccine and antiviral medication distribution (if available).
• Notify KDEM of the need for additional resources.
• Activate SOGs for operational priorities.
• Arrange for facilities (DOC, SNS, as needed) use.
• Document expenses of pandemic response.
Community Resilience and Incident Management – Centers for Disease Control & Prevention
(CDC) Interval: Recognition
Director of the
Division of Public
Health, KDHE
Convene the Pandemic Influenza Planning Committee (PIPC) to
review major elements of the plan and assess preparedness level
✓
KDHE-Pandemic
Influenza Planning
Committee (PIPC)
Review and revise KDHE operating guides and procedures
including contact information
✓
KDHE Operations
and Logistics
Section
Ensure that facilities are ready and available ✓
KDHE
Epidemiology
Branch
Maintain surveillance ✓
Public Information
Officer (PIO),
KDHE
Activate Public Information & Communication (PIC) Plan ✓
KDHE Operations
Section
Begin antiviral and vaccine distribution (if available) ✓
Liaison Officer,
KDHE
Notify emergency management of response and needed support ✓
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 36
Kansas Division of
Emergency
Management
(KDEM)
Provide a Liaison Officer to KDHE Incident Command System
(ICS)
✓
Biosurveillance
The CDC continuously monitors surveillance data reported nationally, and frequently
communicates with public health colleagues around the world so that novel viruses are detected
and investigated as quickly as possible. If Kansas is notified by CDC that a novel influenza virus
has been identified, but efficient transmission of the virus from person-to-person is not yet
established (indicating a novel virus alert), Kansas will enhance Interpandemic Period
surveillance activities by:
• Increasing case detection among persons who recently traveled to the outbreak area and
present with clinical illness possibly caused by influenza including pneumonia, acute
respiratory distress syndrome or other severe respiratory illness. Appropriate specimens
will be collected to diagnose influenza infection. In some situations, if the novel
influenza virus is a highly pathogenic avian strain, such as with the 2004 H5N1 influenza
virus in Asia, local hospital laboratories should not attempt viral isolation because of the
risk the strain could spread. Specimens will be sent to KHEL for sub-typing or to CDC
for sub-typing and isolation. Influenza infection can be diagnosed locally using antigen
detection, immunofluorescence, or PCR. CDC will provide guidance appropriate to each
specific novel virus alert.
• Investigating early cases and clusters of suspect pandemic influenza identified through
ILINet or passive surveillance. BEPHI will be responsible for forwarding case reports to
the local health department, and for specifying which CDC form (e.g. the Pandemic
Influenza Case Investigation Form, the Novel Human Influenza Case Report Form, or an
alternative form suggested by the CDC) to use for case investigations, and for timely
reporting. Local health departments will be responsible for collecting patient histories as
rapidly as possible, and for immediately forwarding complete case investigation forms to
KDHE via fax, secure (encrypted) email, or Kansas’ electronic disease reporting system,
EpiTrax.
• Reporting of early novel and pandemic influenza cases to CDC, likely via an online CDC
case reporting system.
• Ensuring all Interpandemic Period influenza surveillance activities are underway
regardless of the time of year and that all participating laboratories and ILINet providers
are reporting data to CDC each week.
• Sub-typing all influenza A viruses identified in clinical specimens and immediately
reporting to CDC any influenza A viruses that cannot be sub-typed. CDC will provide
instructions on the safe handling of a potential novel influenza virus.
• Obtaining reagents from CDC (as these become available) to detect and identify the
novel strain.
• Reviewing contingency plans for further enhancement of influenza surveillance if
efficient person-to-person transmission of the novel virus is confirmed.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 37
If efficient person-to-person transmission of a novel influenza virus is confirmed, the following
additional surveillance enhancements will be made by BEPHI:
• In collaboration with the KDHE Office of Communications reinforcing the need to screen
travelers arriving in the U.S. from affected countries.
• Investigating the epidemiology of all early cases either originating in the U.S. or that are
imported into the country.
• Promoting increased laboratory diagnosis of influenza at hospitals and emergency
departments, including use of rapid antigen detection tests, for persons with compatible
clinical syndromes, particularly those who may have had recent exposure at the site of an
outbreak. CDC will provide guidance to assist with triage of specimens for testing and for
choosing which isolates to send to CDC.
• Assessing the completeness and timeliness of reports from all participating laboratories
and ILINet providers will be assessed, and non-reporters will be contacted to improve
their performance as necessary.
• Investigating outbreaks and increases in ILI cases, including those detected through the
ILINet surveillance system and those reported through traditional passive surveillance.
Biosurveillance – Centers for Disease Control & Prevention (CDC) Interval: Recognition
KDHE-Bureau of
Epidemiology &
Public Health
Informatics (BEPHI)
Increase case detection among persons who recently traveled to
the outbreak area and present with clinical illness possibly
caused by influenza; including pneumonia, acute respiratory
distress syndrome, or other severe respiratory illness
✓
Report early novel and pandemic influenza cases to CDC ✓
Monitor and institute recommendations from CDC for any
additional surveillance activities that should be undertaken given
the specific circumstances
✓
Review contingency plans for further enhancing influenza
surveillance if efficient person-to-person transmission of the
novel virus is confirmed
✓
Assess the need to screen travelers arriving in the U.S. from
affected countries
✓
Investigate the epidemiology of all early cases either originating
in the U.S. or imported into the country
✓
Investigate early cases and clusters of suspect pandemic
influenza identified through ILINet or passive surveillance
✓
Forward case reports to the local health department, and specify
which CDC form to use for case investigations and timely
reporting
✓
Ensure that all Interpandemic Period influenza surveillance
activities are underway regardless of the time of year and that all
participating laboratories and ILINet providers are reporting data
to CDC each week
✓
Investigate outbreaks and increases in Influenza-like Illnesses
(ILIs)
✓
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 38
Assess the completeness and timeliness of reports from all
participating laboratories and ILINet providers and determine if
improvement measures are necessary
✓
KDHE-Kansas
Health &
Environmental
Laboratories
(KHEL)
Subtype novel viruses ✓
Subtype all influenza A viruses identified in clinical specimens
and reporting any influenza A viruses that cannot be subtyped to
CDC immediately
✓
Obtain reagents from CDC (as reagents become available) to
detect and identify the novel strain
✓
Kansas hospitals At hospitals and emergency departments, increase laboratory
diagnosis of influenza, including use of rapid antigen detection
tests for persons with compatible clinical syndromes,
particularly those who may have had recent exposure at the site
of an outbreak
✓
Surge Management
The PIPC will review this plan and the corresponding SOGs. Procedures and equipment in the
KDHE Department Operations Center will be tested to ensure operational readiness.
Medical Surge
Healthcare system providers will review their emergency plans and procedures to ensure they are
current and workable. Medical surge portions of the plan may be exercised and improvement
plans will be developed and implemented. Isolation procedures will be reviewed and
communicated to all staff. The importance of infection control procedures will be emphasized to
staff, patients and visitors.
The Planning Section within the KDHE ICS will monitor the Kansas Hospital Bed Availability
(HAvBED) system. KDHE, in cooperation with Kansas Health Care Coalitions, will increase
promoting use of this system by Kansas hospitals. Procedures for HAvBED use are in place and
additional training will be made available to local hospital staff. Hospital bed availability, in
concert with other situational data, will help planners at the local and state levels determine the
need for additional care sites and supplies.
Volunteer Management
Additional training will be made available related to the Kansas System for the Early
Registration of Volunteers (K-SERV). This system coordinates the deployment and tracking of
volunteer medical and other professionals during an emergency and provides primary source
verification for these professionals. The K-SERV system has been developed in accordance with
the federal Emergency System for Advance Registration of Volunteer Health Professionals
(ESAR-VHP) standards. Requests for additional volunteers will be coordinated through the
local EOCs, like other requests for additional support. Local volunteer coordinators have access
to K-SERV and will be able to utilize the system according to procedures already developed and
disseminated.
Surge Management – Centers for Disease Control & Prevention (CDC) Interval: Recognition
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 39
Kansas hospitals Review emergency plans and procedures and ensure all facets
are current and workable
✓
Exercise and improve medical surge portions of hospital
emergency plans and corresponding procedures
✓
Inventory personal protective equipment and order additional
supplies as identified
✓
Provide additional infection control procedure training to staff,
patients, and visitors
✓
Planning and
Outreach Specialist,
KDHE-Bureau of
Community Health
Systems (BCHS)
Provide additional training opportunities for Kansas System for
the Early Registration of Volunteers (K-SERV) for county
volunteer coordinators
✓
KDHE Planning
Section
Monitor Kansas Hospital Available Beds for Emergency
Disaster HAvBED system for bed availabilities in hospitals
✓
Kansas Health Care
Coalitions
Promote the twice daily update of the Kansas HavBED system
by hospitals
✓
KDHE-Pandemic
Influenza Planning
Committee (PIPC)
Review Kansas Pandemic Influenza Preparedness and Response
Plan and corresponding Standard Operating Guides (SOGs)
✓
KDHE Logistics and
Operations Sections
Review procedures and equipment in the KDHE Emergency
Operations Procedures for operational readiness
✓
Information Management
Once sustained human-to-human transmission is confirmed anywhere in the world, KDHE
Public Information staff will:
• Review major elements of the PIC Plan with partners and stakeholders.
• Disseminate information to public, partners, and the media on an ongoing basis.
• Monitor media coverage and address misinformation.
• Coordinate with bordering jurisdictions.
Emergency Public Information and Warning
The KDHE Director of Communications serves as the Public Information Officer (PIO) under
the KDHE ICS. The PIO and their staff maintain a system to effectively communicate with
public health officials, healthcare professionals, and other targeted audiences. This system is
described in the KDHE PIC Plan, and describes the following activities that would be conducted
by the PIO and their staff:
• Review communication materials and revise as needed
• Activate public hotline, if needed
• Disseminate information to public and partners on an ongoing basis
• Educate public health officials, elected officials, community leaders, and the media about
what information will and will not be available during a pandemic
• Prepare spokespersons
• Coordinate information sharing with bordering jurisdictions.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 40
Information Sharing
Kansas Health Alert Network notifications will be sent to all appropriate state and local response
partners informing them of preparedness activities.
Information Management – Centers for Disease Control & Prevention (CDC) Interval:
Recognition
Director of
Communications,
KDHE
Review materials and revise as needed ✓
Activate public hotline ✓
Disseminate information to public and partners on an ongoing
basis
✓
Educate public health officials, elected officials, community
leaders, and the media about what information will and will not
be available during a pandemic
✓
Prepare spokespersons ✓
Coordinate communications plan with bordering jurisdictions ✓
Review major elements of the Public Information &
Communication (PIC) plan with partners and stakeholders
✓
Monitor media coverage and address misinformation ✓
Coordinate with the Community Mitigation Branch regarding
messages related to non-pharmaceutical interventions
✓
Respond to media requests for interviews as needed ✓
Countermeasures and Mitigation
Plans and SOGs will be reviewed and updated with incident information including updated
contact lists.
Medical Countermeasure Dispensing
Once human transmission is confirmed, local public health agencies will ensure human resources
and logistics are in place to begin vaccination, taking into account the need for additional staff
due to illness and relief for workers. Just-in-time-training should be implemented for relevant
agencies and partner groups regarding vaccine delivery protocols and procedures. Activities will
be coordinated with border states and the Kansas City Metro Area.
Medical Materiel Management and Distribution
Local and state health authorities will meet with appropriate partners and stakeholders and
review major elements of SNS plans and SOGs. Plans will be modified to account for any
updates on recommended target groups, projected vaccine supply and human resources.
Once a novel virus has been identified, KDHE staff will review the distribution and priority
prophylaxis and treatment plans to ensure they are updated. The medical community will be
notified of the status of the plans and the availability of antiviral medications. KDHE will
distribute guidelines to the medical community and conduct training for public health staff
involved in antiviral distribution protocols and procedures.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 41
HHS will deploy the antiviral stockpile to state and tribal entities and to federal departments and
agencies, along with prioritization and treatment recommendations. HHS will notify the Kansas
Medical Countermeasure Program Manager to coordinate receipt.
Non-Pharmaceutical Interventions
Containment plans and SOGs will be reviewed and updated. State and local public health
departments will continue to stress prevention messages and provide social distancing education
to businesses, schools and community leaders.
Responder Safety and Health
All health and medical sector organizations will be advised of the importance of infection control
as an overall mitigation strategy. Organizations should inventory personal protective equipment
(PPE) and additional stocks may be ordered.
Countermeasures and Mitigation – Centers for Disease Control & Prevention (CDC) Interval:
Recognition
Medical
Countermeasures
Coordinator, KDHE-
Bureau of
Community Health
Systems (BCHS)
Meet with partners agencies and stakeholders to review state
Strategic National Stockpile (SNS) plans and procedures
✓
Local health
departments
Meet with partners agencies and stakeholders to review local
mass dispensing plans and procedures
✓
KDHE-Pandemic
Influenza Planning
Committee (PIPC)
Recommend target groups based upon projected vaccine supply
and available resources
✓
Director of the
Division of Public
Health, KDHE
Develop communications to the medical community convening
the availability of antiviral medication and treatment protocols
✓
Public Information
Officer (PIO),
KDHE
Develop and release stress prevention messages included in the
social distancing education to target areas
✓
Local health
departments
Provide just-in-time refresher training to volunteers and
assisting agencies for vaccination campaigns
✓
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 42
World Health
Organization (WHO)
Phases
Centers for Disease Control & Prevention (CDC) Intervals
Pandemic
Phase
Global
spread of
human
influenza
caused by a
new
subtype
Initiation:
Initiation of a
pandemic
wave
Confirmation of human cases of a pandemic influenza virus anywhere in
the world with demonstrated efficient and sustained human-to-human
transmission
Acceleration:
Acceleration
of a pandemic
wave
Consistently increasing rate of pandemic influenza cases identified in the
United States, indicating established transmission
Deceleration:
Deceleration
of a pandemic
wave
Consistently decreasing rate of pandemic influenza cases in the United
States
Community Resilience and Incident Management
KDHE will activate ICS and organize incident management activities in the DOC. The KDHE
Emergency Readiness Initiative would likely be activated which allows for the use of all KDHE
staff to be available to assist with incident management and response activities.
Emergency Operations Coordination
KDHE has developed pandemic influenza triggers that delineate staffing and appropriate actions
for various trigger points during the pandemic alert period. Those trigger points are as follows:
1. World Health Organization declares Pandemic Phase, U.S. Government moves to the
Initiation, Acceleration and Deceleration Interval and identifies the Pandemic Severity
Index (PSI) for the particular causative virus. HHS notifies Medical Countermeasure
Program Manager they will implement the Influenza Pandemic Asset Deployment
Strategy. Kansas identifies itself as Interval Initiation.
2. The Kansas Receipt, Staging, and Storage (RSS) Warehouse is activated to receive
assets.
3. The U.S. Government declares Interval Acceleration - Consistently increasing rate of
pandemic influenza cases identified in the United States, indicating established
transmission – First case in Kansas. Actions based upon federal guidance for respective
stage, PSI and respective intervals.
a. Kansas asynchronously identifies affected geographic area as Acceleration
Interval with concomitant actions surrounding the initiation element.
b. Kansas detects secondary clusters. Kansas continues asynchronous local and
regional interval designations.
c. Kansas activates community mitigation interventions for affected communities.
4. The U.S. Government declares Interval Deceleration and preparation for subsequent
waves.
a. Asynchronously within the state, evident signs of infection rate reductions
become apparent and affected areas are identified as Interval Deceleration.
b. As cases become more sporadic, interval designations of resolution are declared
for areas and communities of the state where surveillance supports the identified
interval.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 43
Complexity and variability of actions surrounding WHO Phases and CDC Intervals will require
coordinated incident management activities between KDHE programs and other local, state and
federal response partners. Trigger points were used for deciding staffing of the KDHE ICS. Since
the antiviral medication shipment will necessitate activating an RSS Warehouse, KDHE will
activate the Departmental Operations Center and additionally staff the ICS.
The KDA is responsible for all food safety programs in Kansas. Food safety has been identified
as the number one priority for KDA in the event of any crisis that would affect the ability of the
agency to carry out essential functions, which would include a pandemic. Personnel assigned to
food safety responsibilities are located throughout the state and cross-training has occurred with
all staff. These staff will be used in place of current staff if they are unavailable to provide
inspections. Inspections will be conducted during all phases of a pandemic.
All state-inspected slaughter/processing establishments will be directed to communicate
problems and resource requests to their local EOCs. It is anticipated that many of these facilities
will still contact their assigned inspector or the KDA directly, and that information will be shared
with the local EOC. The ESF 11 coordinator in the SEOC will coordinate resource requests with
other ESF Coordinators and the logistics personnel, as needed. Status of food producers will be
maintained by the ESF 11 Coordinator and provided to the planning section in the SEOC as
requested. Due to the large number of regulated facilities, only those experiencing problems will
be included in the status reports. Facilities able to continue business as usual will not be tracked
or reported on.
It is unlikely that state-level response teams would be needed (or available) to carry out state-
administered nutritional assistance and agriculture emergency response support responsibilities
during a pandemic. The nutritional assistance programs are managed by a handful of state-level
managers on a day-to-day basis. The overwhelming majority of program implementation
activity is done at the local level. School districts administer school nutrition programs, the local
and state health departments manage the Women, Infants and Children (WIC) program, hundreds
of nongovernmental entities implement commodities programs, and the Supplemental Nutrition
Assistance Program is administered by the Kansas Department for Children and Families. If the
local agencies have not prioritized these programs in their continuity of operations planning,
there is little that can be done from the state level. As mentioned previously, the newly formed
group will be working to develop some guidance, but there are few regulatory avenues that
would be available to require local entities to administer these programs during a pandemic, with
the exception of the Supplemental Nutrition Assistance Program. The state agency is required to
accept and process applications, even in the event of a pandemic. Kansas Department for
Children and Families (DCF) field staff would carry out these functions with alternative methods
as deemed necessary in a pandemic.
Agriculture emergency response support would be provided the same way in a pandemic as it is
for other disasters and emergencies in Kansas. Critical response activities are prioritized in all
state agency COOPs. It is anticipated that state agencies will be able to provide very little
additional support to local jurisdictions during a severe pandemic. Plans are being developed to
ensure that essential public safety and public health programs can continue, even with a potential
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 44
50 percent reduction in staff. It would not be prudent to assume that resources above and beyond
that would be available.
The newly formed Nutritional Assistance Group is developing procedures for alternative
approaches for carrying out state-administered nutritional assistance during a pandemic. The
KDA will serve as the ESF 11 coordinating agency in the event of a pandemic. Nutritional
assistance program status will be reported on a weekly basis to the ESF 11 desk in the SEOC. If
there are problems or needs, program managers will also report these to the ESF 11 desk as they
occur. In the event of an agriculture or animal disease emergency, the producers will notify their
local EOC. Requests for assistance will be routed to the ESF 11 desk in the SEOC.
The KDHE Commander with the approval of the Secretary of KDHE may choose to advise the
Governor through The Adjutant General of the State of Disaster Emergency for the influenza
pandemic.
If a State of Disaster Emergency is declared by the Governor a recommendation that all state
government agencies implement their COOPs may be made. A major focus of these COOPs
shall include limiting work hours to personnel who perform priority COOP functions. This
limiting of state workers is expected to have the effect of limiting the disease spread among the
workforce and be part of the state’s overall layered disease mitigation strategy.
In an effort to reduce and delay the spread of infection through the state workforce, the KDHE
Commander may recommend the implementation of COOP measures to the Governor’s Office,
through the Secretary of KDHE and The Adjutant General’s Department, for all state agencies.
The implementation of these measures may be dictated by the PSI and result in the reductions of
state functions corresponding to that severity. When there is a COOP event (a significant
disruption of state government or agency business operations) then all affected agencies shall
promptly:
1. Follow established notification and decision making procedures, as specified in the
respective agency COOP.
2. Notify the governor (or their designated representative) about the situation and extent of
plan activation.
3. Notify KDEM, who will subsequently notify the appropriate county’s office of
emergency management
The JIC will coordinate the release of this information with the Governor’s Office to the citizens
of Kansas.
Community Recovery
Recovery items related to the Pandemic Phase are addressed in CDC Interval: Preparation. .
Community Resilience and Incident Management – Centers for Disease Control & Prevention
(CDC) Intervals: Initiation, Acceleration, and Deceleration
Kansas Department
of Agriculture
(KDA)
Ensure all food producers, transporters, retailers, and consumers
are aware of information and educational resources prior to,
during, and after a pandemic
✓
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 45
Assist farm-to-fork operators with planning for the human
resource challenges that may affect their businesses during a
pandemic
✓
Serve as a source of information for stakeholders regarding state
and local actions and resources available to producers during a
pandemic
✓
Engage in vigorous continuity of operations planning to ensure
that the department can continue to provide the services
necessary to maintain the integrity and safety of the food supply
✓
KDHE Command The KDHE Commander will activate the KDHE Department
Operations Center and fully activate the response plan
✓
The Planning Section Chief will monitor staffing needs and
recruit additional staff, if necessary
✓
The Liaison Officer will ensure activities are coordinated with
the bordering states of Missouri, Nebraska, Oklahoma and
Colorado, as well as the Kansas City Metro Area
✓
The KDHE Commander will ensure that CDC is briefed on the
actions occurring in Kansas
✓
The Finance Section Chief will document the expenses related to
responding to a pandemic influenza outbreak
✓
The Operations Section Chief will ensure coordination of
BEPHI response activities with those of the local health
departments and the medical community
✓
The KDHE Commander, in coordination with the KDHE
Secretary and The Adjutant General of Kansas, will determine
when to advise the Governor to declare a State of Disaster
Emergency in response to the influenza pandemic
✓
The Kansas Health & Environmental Laboratories (KHEL) will
provide testing and technical support to the pandemic response,
coordinate the response of the Kansas Laboratory Response
Network, and provide guidance to clinical laboratories statewide
✓
The Planning Section Chief will monitor staffing needs at the
KDHE
✓
Biosurveillance
The Epidemiological Branch Director in the KDHE ICS will ensure that studies are in place to
monitor vaccine effectiveness as well as assess the quality of surveillance and make
recommendations for improvement during the period between pandemic waves and after the
pandemic. In addition, the Epidemiological Branch will be responsible for tracking adverse
events to vaccine and treatment. The Epidemiological Branch Director will also coordinate the
monitoring of health impacts, including deaths and hospitalizations, from influenza.
Public Health Surveillance and Epidemiological Investigation
KDHE–OVS has implemented an electronic death reporting system. Personnel within the OVS
and BEPHI can access the system, and build queries regarding deaths from specific causes, such
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 46
as influenza or pneumonia. In the event that the electronic death reporting system is not
operational, influenza-associated deaths will be tabulated manually, using traditional, paper-
based methods.
During the early period of the pandemic, the Epidemiological Branch will use information
gathered from local health departments’ case investigations, WebEOC, and the OVS electronic
death reporting system to determine the disease’s attack and case-fatality rates, the number and
rate of pandemic-associated hospitalizations, the number of pandemic-associated deaths, and the
numbers of newly isolated and quarantined individuals. Tabulated data may be transmitted to
the CDC as requested.
The Epidemiological Branch, with assistance from OVS, may utilize bridged estimates from the
National Center for Health Statistics to calculate estimated rates of influenza-associated
hospitalization.
The Planning Section, in cooperation with the Kansas Division of Emergency Management, will
measure absenteeism in key industries. The Kansas Division of Emergency Management, which
regularly partners with key industries and critical infrastructure in Kansas, may reach out to the
many organizations and sectors that may suffer from reduced workforces. Collecting
information on the number of ill workers, as well as possible impacts to critical business
functions, may help provide a more complete understanding of the disease’s impact to Kansas
communities.
In the event of a suspect or confirmed case of pathogenic avian influenza, the Animal Health
Commissioner will contact the State Epidemiologist or designee via the Epidemiology Hotline,
in addition to contacting The Adjutant General’s Department via email.
Public Health Laboratory Testing
Studies have demonstrated a dramatic increase in antiviral medication resistance in some
commonly circulating influenza strains to certain antiviral medications. The technology required
to perform antiviral resistance testing is not available to most laboratories, including KHEL. In
response, CDC has implemented an enhanced antiviral resistance testing and surveillance
program. Each of the CDC Collaborating Laboratories is asked to submit a certain portion of
influenza isolates to CDC. KHEL is participating in this surveillance program and will submit an
increased number of specimens for antiviral resistance monitoring.
Biosurveillance – Centers for Disease Control & Prevention (CDC) Intervals: Initiation,
Acceleration, and Deceleration
KDHE Command Recommend the implementation of Continuity of Operations
(COOPs) to the Governor’s Office through the Secretary of
KDHE and The Adjutant General’s Department for all state
agencies
✓
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 47
KDHE-Kansas
Health &
Environmental
Laboratories
(KHEL)
Assist CDC with monitoring for antiviral resistance ✓
KDHE
Epidemiological
Branch
Ensure that studies are in place to monitor vaccine effectiveness ✓
Coordinate monitoring of health impacts including deaths and
hospitalizations from influenza
✓
Determine the disease’s attack and case-fatality rates ✓
Assess the quality of surveillance and make recommendations
for improvement
✓
Track adverse events to vaccine and treatment ✓
KDHE Planning
Section and Kansas
Division of
Emergency
Management
Measure absenteeism in key industries ✓
Surge Management
KDHE will implement generic elements of the response plans and specific plans for identified
pandemic influenza issues, including continuous collection of data concerning medical and
material supplies and their allocation, in order to rapidly identify changing patterns of need and
modify or redirect policy.
Medical Surge
Depending upon the severity of the pandemic, communities may choose to utilize alternate care
facilities for patients presenting with symptoms of pandemic influenza. These alternate care sites
may be utilized to facilitate congregate care of similarly symptomatic patients that do not require
intensive medical treatments. The use of these facilities by communities could prove effective in
maintaining hospital availability for those with severe complications or other non-pandemic
related medical emergencies such as labor and delivery, traumas, and normal daily emergency
room situations.
The Disease Containment Branch will coordinate the provision of infection control measure
messages to healthcare delivery personnel as well as the general public. KDHE will coordinate
best practice recommendations from the CDC, HHS, and Association for Professionals in
Infection Control and Epidemiology (APIC). This information will be shared via a variety of
avenues including the JIC and KS-HAN, in partnership with the Kansas Hospital Association,
the Kansas APIC chapters and the Kansas Board of Emergency Medical Services (KBEMS).
The role of behavioral health professionals in pandemic response is important for the health of
Kansans. Continuity of operations plans estimates the reduction of services during this time.
This reduction of services may have many effects on the employment status of Kansans.
Behavioral health providers will have a role in drafting messages and providing services to
established clients and the general population during this time. These messages may also
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 48
address the expectation of deaths at places other than medical care facilities, depending on the
severity of the pandemic.
Once the pandemic is underway and healthcare providers rely on clinical criteria rapid test kits,
more diagnostic activities may be conducted locally and fewer shipments may be needed. Public
health laboratories should continue to build partnerships with healthcare providers in their
jurisdictions, including physicians who participate in the ILINet during the regular influenza
season.
Additional durable medical equipment and supplies, including mechanical ventilators, may be
available from the SNS. Normal requesting procedures will be followed for medical facilities,
alternate care sites, and other appropriate locations to request this equipment. Requests for
mechanical ventilator equipment must include:
• Make
• Model number
• Amount requested
• Number of ventilators already in service
• Number of available trained and qualified staff to operate additional ventilator(s)
• Available space to accommodate additional ventilated patients
• Additional supply needs
The state EOC in consultation with KDHE will evaluate the requests for mechanical ventilators
based on:
• Proportion of jurisdictional population in relation to Kansas total population
• Disease incidence proportional to jurisdictional population
• Number of intensive care unit beds in the requesting facility
• Order in which the request was made
• Availability of trained and qualified staff to operate additional ventilator(s)
• Availability of space to accommodate additional ventilated patients
• Additional equipment/supply requests to support additional ventilators
During an extremely severe pandemic, the circumstances of the pandemic may be so dire, when
all medical resources have been allocated or are in extremely short supply and are insufficient to
address the healthcare needs of all the victims. Hospitals may be requested by the Director of the
Division of Public Health to institute modified health care protocols consistent with the
recommendations in the Guidelines for the Use of Modified Health Care Protocols in Acute Care
Hospitals During Public Health Emergencies. These guidelines are available to communities to
enhance their medical surge planning at
http://www.kdheks.gov/cphp/download/Crisis_Protocols.pdf.
Fatality Management
In the event of mass fatalities caused by pandemic influenza, it may be necessary to establish a
virtual Family Assistance Center where information can be received and disseminated by means
other than personal contact, in order to reduce potential exposure to virus. Additional
information concerning the manner in which Kansas will address a mass fatality incident may be
located in the Kansas Mass Fatality Plan attached to the Kansas Response Plan. KDHE may
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 49
request coroners and other physicians certifying cause of death to explicitly indicate if pandemic
influenza is determined to be a cause of death.
Surge Management – Centers for Disease Control & Prevention (CDC) Intervals: Initiation,
Acceleration, and Deceleration
KDHE Disease
Containment Branch
Provide infection control messages to healthcare personnel ✓
Coordinate best practice recommendations and share this
information with the State Joint Information Center (JIC) and
local partners
✓
Kansas communities Activate and staff alternate care sites, if applicable ✓
Information Management
Using the communication systems identified during the Interpandemic Period, public
information staff will update appropriate agencies and the public at least weekly and as needed
regarding any new information regarding the novel virus and its impact. Materials and messages
will be reviewed and modified as needed with information from the CDC, HHS, and infection
control specialists.
Emergency Public Information and Warning
When the SEOC is activated, the state JIC will also be activated. KDHE’s PIO will serve with
the JIC to ensure consistency of information from the State of Kansas. JIC activities will be
coordinated with bordering states and the Kansas City Metro Region. In addition to the
messages provided by KDHE, KDA will coordinate with the nutritional assistance program
managers and advise the public regarding availability of nutritional assistance programs. In
addition to the messages provided by KDHE, KDA will advise the public regarding food product
recalls, safe food handling procedures, and any issues regarding shortages, substitutions, etc.
Information Management
KDHE public information staff may conduct scheduled conference calls with interested local
health departments, hospitals, and other medical providers to increase information sharing and
provide briefings prior to the release of pandemic influenza message campaigns.
KDA will coordinate with partner agencies to ensure that all applicable nutrition assistance
program information is provided to stakeholders during the Pandemic Period. KDA will assume
the role as the ESF 11 coordinating agency during the pandemic response. A key component of
this role is to coordinate the response to agricultural emergencies. KDA will continue to monitor
the agriculture sector and provide necessary information and resources, if available, to ensure the
continuity of food production in Kansas.
KDA will ensure that all applicable food safety information is provided to stakeholders during
the pandemic period. KDA will also communicate with agricultural producers and other
regulated entities to help KDHE provide messages regarding disease containment in the
workplace and updates on the status of the pandemic.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 50
Information Management – Centers for Disease Control & Prevention (CDC) Intervals:
Initiation, Acceleration, and Deceleration
State Joint
Information Center
(JIC)
Provide updated information to appropriate agencies and the
public at least weekly and as needed regarding virus and impact
✓
Kansas Department
of Agriculture
(KDA)
Provide all applicable nutrition assistance program information
to stakeholders
✓
Countermeasures and Mitigation
The timely and appropriate application of mitigation activities and countermeasure strategies
could have the effect of reducing the impact of the pandemic on Kansas.
Medical Countermeasure Dispensing
KDHE may activate the Department Operations Center and distribute vaccine and supplies
necessary for influenza vaccine administration (e.g., needles and syringes) through a centralized
distribution system to local health departments using SNS infrastructure or utilize the federal
vaccine distribution system. Utilization of the federal vaccine distribution system in this instance
will be preferable to better ensure the viability and stability of the vaccine. In addition, the
federal vaccine distribution system already has mechanisms in place to maintain cold chain
custody of the material. As part of ongoing pandemic influenza planning efforts, KDHE may
work with vaccine distributors to develop a state-controlled distribution system. This system
may be utilized in a situation where total vaccine distribution is the responsibility of the state or
in a situation where distribution below a required threshold determined by the federal
government is needed. In either instance, distribution of a specified number of doses of vaccine
and medical supplies is based upon population and distribution of prioritized at-risk or essential
services personnel and request of the county. Supplies to support vaccination efforts may be
shipped separately from vaccine, depending on the availability of supplies.
A state-controlled distribution of vaccine will be in-place during pandemic response. KDHE will
focus distribution of vaccine and vaccine administration supplies to local health departments and
hospitals within the state of Kansas. Utilizing vaccination rate data supplied by local health
departments and hospitals to KDHE’s Planning Section, KDHE will determine the appropriate
time and manner to begin providing state-controlled vaccine to other health and medical sector
partners including commercial pharmacies. This determination will include the adequacy of
vaccine and supplies, hospital and health department pandemic response work load factors, and
trends in vaccination rates.
Medical Materiel Management and Distribution
If needed, KDHE will consult with KDEM and SEOC staff to help coordinate the storage,
security, and transportation of vaccine and supplies. As previously mentioned, this distribution
effort may be in accordance with previously planned and exercised SNS infrastructure. It will be
crucial to continue close coordination with local, state and federal partners.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 51
The Disease Containment Branch may also assist in the distribution of pneumococcal vaccine for
high-risk individuals in the event of supply shortage. Those high-risk individuals will be
identified and prioritized at the local level in much the same way as the influenza vaccine. The
SNS infrastructure may be utilized for distributing these measures.
Once the onset of a pandemic is confirmed, KDHE will fully activate the antiviral medication
distribution plan. These medications will be provided to healthcare facilities for the treatment of
pandemic influenza patients according to guidance and requirements set forth by the federal
government.
Non-Pharmaceutical Interventions
Epidemiological Branch staff will monitor adverse reactions to influenza vaccine using the
VAERS. This effort will be in coordination with the monitoring of infection and fatality rates
associated with the virus. Epidemiological studies of cases, adverse reactions, trends, and
effectiveness of containment measures will be conducted using standard epidemiological
techniques and methodologies. This information will assist state planners and response staff in
determining the effectiveness of the vaccine and the need for additional disease containment
measures. To promote accurate epidemiological investigations at all levels of government, it is
important for local health departments, hospitals, physicians, and other health and medical
professionals to be alert for any reactions or trends and report them via VAERS.
Responder Health and Safety
In a severe pandemic, KDHE may promote vaccination of those state government officials and
state and federal personnel deemed as priority for maintaining essential services. Utilizing
similar methodologies as local jurisdictions, the State of Kansas will identify these personnel.
KDHE will coordinate the provision of vaccine to these individuals to promote continuity of
government.
Countermeasures and Mitigation – Centers for Disease Control & Prevention (CDC) Intervals:
Initiation, Acceleration, and Deceleration
KDHE Strategic
National Stockpile
(SNS) and Receipt,
Staging & Storage
(RSS) Units
Distribute vaccine, supplies, antiviral medication, and other
medical supplies
✓
KDHE
Epidemiological
Branch
Monitor adverse reactions to influenza vaccine in VAERS
✓
KDHE Disease
Containment Branch
Assist in distribution of pneumococcal vaccine for high-risk
individuals
✓
Local health and
medical
professionals
Report any adverse reactions to vaccinations or trends to KDHE
Epi Hotline
✓
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 52
World Health Organization
(WHO) Phases Centers for Disease Control & Prevention (CDC) Intervals
Transition
Phase
Reduction in
global risk,
reduction in
response
activities, or
progression
toward recovery
actions
Preparation:
Preparation
for future
pandemic
waves
Low pandemic influenza activity but continued outbreaks possible
in some jurisdictions
As the pandemic impacts in Kansas begin to wane, response activities will reduce and cease as
appropriate for the conditions. When the pandemic has been declared ‘over,’ local and state
response will return to Interpandemic Period activities.
Community Resilience and Incident Management
Community Recovery
State ESFs will continue activities into the recovery phase as outlined in the base Kansas
Response Plan. Restoration of services for the health and medical community, including
congregate living services, behavioral health, healthcare, public health, EMS, and laboratory
services, will be coordinated by KDHE. The focus will be on returning local communities to
Interpandemic Period capabilities as quickly and efficiently as possible. KDHE will work with
licensure entities in Kansas to restore applicable levels of oversight to those disciplines. Within
the KDHE ICS is a Health Recovery Branch, which promotes coordinated community
restoration efforts by working with the KDHE Division of Public Health. Regulatory inspections
of hospitals and other KDHE-regulated entities will resume as scheduled and defined in
procedure. Recommendations concerning standards of care for both medical care and pre-
hospital care arenas will continue to be revised and released as information related to infection
and best practices becomes available.
The food supply system will be assessed as needed. Inspections will be conducted on the same
schedule as the Interpandemic Period, unless problems or issues are reported to KDA in
accordance with current procedures. In the final stages of the pandemic, KDA will ensure that
all applicable food safety, agriculture, and nutritional assistance information is provided to the
public and regulated entities to continue the precautions identified in previous phases.
Emergency Operations Coordination
The SEOC will continue to monitor and coordinate with identified critical infrastructure and key
assets. Recovery of these assets will promote recovery of the entire state. As assets begin to
return to Interpandemic Period operations, the interaction with the SEOC will decrease.
Termination of COOP and return to normal operations.
The State of Kansas utilizes the Homeland Security Exercise Evaluation Program (HSEEP) to
evaluate response and recovery tasks associated with exercises and emergency incidents.
Utilizing HSEEP, KDHE will work with appropriate partners at the state, local and federal level
to develop improvement plans for the KDHE Department Operations Center, RSS Warehouse
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 53
and SEOC based on the after action reviews for each of those venues. Specific modification of
the response plans and operating guides or procedures will be implemented as needed.
Biosurveillance
Public Health Surveillance and Epidemiological Investigation
In addition to HSEEP evaluation methodology, epidemiological studies and reports will identify
strengths and weaknesses of response measures, those particularly related to community disease
containment, vaccination, and healthcare efforts.
Surge Management
Medical Surge
Return of SNS or other cache durable medical equipment.
Modified protocol use ceased.
Alternate Care Sites demobilized.
Information Management
Return to Interpandemic activities related to disease prevention habits and include appropriate
sharing of lessons learned with varied audiences both public and professional.
Emergency Public Information and Warning
Work with the public to remain vigilant for following waves and to continue good disease
prevention habits.
Information Sharing
Focus on communication of lessons learned and recovery activities.
Countermeasures and Mitigation
Accountability for used and unused medications, vaccines, and medical supplies.
Medical Countermeasure Dispensing
Return of antiviral medication and/or unused vaccine.
Medical Materiel Management and Distribution
Recovery of state and SNS durable medical equipment.
Responder Safety and Health
It is important to recognize that a severe influenza pandemic will likely have a significant mental
health effect on people living in Kansas, responders and government officials. During the times
between pandemic waves, behavioral health professionals may be needed across all sectors of
society to promote resiliency and provide crisis counseling and stress management opportunities
for individuals. Considering the likely economic impact workers will face as a result of a severe
pandemic, behavioral health providers will potentially be called upon by industry to assist with
individuals being returned to work, or with workers displaced because of reductions in work
load.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 54
Community Recovery – Centers for Disease Control & Prevention (CDC) Interval:
Preparation
All responding
organizations
Perform after action reviews and implement improvement plan
action items
✓
Regulating agencies Restoration of regulating activities to pre-pandemic schedule
and procedure
✓
KDHE Coordination of restoration of health and medical services ✓
Continue to revise and release recommendation concerning
standards of care
✓
State Emergency
Operations Center
(SEOC)
Coordinate with critical resources and key assets to promote
recovery and monitor degree of impact to operations
✓
Plan Development and Maintenance The Pandemic Influenza Planning Committee reviews lessons learned, after action reports,
improvement plans and new pandemic planning guidance to further develop this plan. The
Kansas Pandemic Influenza Preparedness and Response Plan is reviewed and updated during the
fall of each calendar year. A revised plan is scheduled for release during the month of January of
each year.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 55
Authorities and References
State Legal Authority
Statute Section Authority
Disposition of Human
Remains
65-123
Disposal of human remains during
state of emergency relating to public
health
Health, Administration and
Supervision
65-101
65-Articles 1 and 2
65-101
65-101
Duties of the Secretary of Health and
Environment
Public health system
Powers and duties of the department
(KDHE) (Powers of the secretary)
Powers and duties of the department as
public health authority
Local Health Officials
65-201
65-119 and 202
Local board of health; powers and
duties
Local health officer; qualifications and
duties
Communicable Diseases
65-101
65-119
65-119, 126, and 128
65-118
65-127 and 129
Powers and duties of department
(given as powers of the secretary)
Duties of local health officers
Isolation and quarantine
Communicable diseases; suspected
cases; protection of the public
(reporting suspected case)
Violation of law relating to health
Investigation of Deaths
65-123 Funeral for someone who dies of
communicable disease
Control of Communicable
Diseases
65-118
65-119
65-119
Reports of communicable diseases
(protection against liability and the
necessity of reporting)
Investigation and control of
communicable diseases
General statement of powers for
control of communicable diseases
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 56
65-128
Isolation and quarantine
Disasters, responsibilities of
the Governor, state of
disaster emergency
48-924 Issuance of proclamation of
emergency
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 57
Glossary Characterization
Identification of the strain of an influenza virus such as A/Panama
DMORT
A coordinated effort of forensic experts and mortuary personnel to
effectively handle a mass fatality disaster
Endemic
A disease that is continually present in a community or a region
Enzootic Affecting or peculiar to animals of a specific geographic area.
Epidemic
The occurrence of a disease in a community or region clearly in excess of
normal expectations
Epizootic Affecting a large number of animals at the same time within a particular
region or geographic area.
Health Alert
Network
An Internet-based service used to communicate health and emergency
messages
Influenza-like
illness (ILI)
The presence of fever >100 F, with a cough or sore throat
JIC
A Joint Information Center is a central location for involved agencies to
coordinate public information activities and a forum for news media
representatives to receive disaster or emergency information
Novel virus
A virus rarely or not previously known to infect humans
Pandemic
The occurrence of a disease in excess of normal expectations in extensive
regions, countries and continents
PCR Polymerase chain reaction is a laboratory method used to isolate and amplify
a fragment or sequence of DNA. The technique allows for the rapid
identification of organisms such as bacteria, fungi, and viruses.
Strategic National
Stockpile (SNS)
A federal cache of medical supplies and equipment to be used in emergency
and disaster situations
Subtype Identification of influenza A viruses according to the hemagglutinin (H) and
neuraminidase (N) components of the virus, such as H1N1 or H3N2
Surveillance
The collection, analysis and dissemination of data
Syndromic
Occurring as part of a complex of signs and symptoms suggesting the
existence of an undesirable condition or disease
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 58
Acronyms and Abbreviations ACIP Advisory Committee on Immunization Practices
BDCP Bureau of Disease Control and Prevention
BIA Biological Incident Annex
BCHS Bureau of Community Health Systems
BEPHI Bureau of Epidemiology and Public Health Informatics
CDC U.S. Centers for Disease Control and Prevention
COOP Continuity of Operations
DHS U.S. Department of Homeland Security
DMORT Disaster Mortuary Operational Response Team
DOPH Division of Public Health
EIS Epidemic Intelligence Service
EMT Emergency Medical Technician
EOC Emergency Operations Center
EOP Emergency Operations Plan
ESF Emergency Support Function
FDA U.S. Food and Drug Administration
FEMA U.S. Federal Emergency Management Agency
HAvBED Kansas Hospital Bed Availability System
HHS U.S. Department of Health and Human Services
HSEEP Homeland Security Exercise Evaluation Program
IAL Incident Action Level
ICP Infection Control Professional
ICS Incident Command System
IDER BEPHI Infectious Disease Epidemiology and Emergency Response Section
ILI Influenza-like illness
IND Investigational New Drug Application
JIC Joint Information Center
KBEMS Kansas Board of Emergency Medical Services
KDA Kansas Department of Agriculture
KDEM Kansas Division of Emergency Management
KDHE Kansas Department of Health and Environment
KHEL Kansas Health and Environmental Laboratories
KS-HAN Kansas Health Alert Network
LHD Local Health Department
LIN Laboratory Information Network
NIMS National Incident Management System
NREVSS National Respiratory and Enteric Virus Surveillance System
NRF National Response Framework
OIE World Organization for Animal Health
OVS Office of Vital Statistics
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 59
PCR Polymerase Chain Reaction
PIC
PIO
Public Information and Communication
Public Information Officer
PIPC Pandemic Influenza Preparedness Committee
PPE Personal Protective Equipment
PSAF Pandemic Severity Assessment Framework
PSAP Public Safety Answering Point
RSS Receipt, Staging and Storage
RT-PCR Real Time Polymerase Chain Reaction
SEOC State Emergency Operations Center
SNS Strategic National Stockpile
SOG Standard Operating Guide
USDA U.S. Department of Agriculture
USG United States Government
VAERS Vaccine Adverse Events Reporting System
VIS Vaccine Information Statement
VOAD Voluntary Organizations Active in Disasters
WHO World Health Organization
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 60
Appendices
Appendix A –Health Emergency Activation Levels Health Emergency Activation Levels
Level 1 – Normal Operations
• Day-to-day operations
• IDER monitors surveillance systems statewide
• Epidemiologist on-call is notified of reportable
diseases or unusual events
• Contact with the Epidemiologist on-call is made
24/7 via the Epi Hotline (1-877-427-7317)
• Influenza surveillance coordinator gathers
information on ILI activity in the state on a
weekly basis
Level 2 – Watch
• Passive and sentinel surveillance indicates that an
usual event or outbreak has occurred and further
case ascertainment is needed
• Active and enhanced surveillance initiated at the
State and/or Local levels
• Decision makers are able to mobilize internal
resources to identify and contain diseases
• KS-HAN notifications sent to appropriate health
departments, physicians, hospitals, and sentinel
sites
• Epidemiological investigation is conducted by
state and local health department staff
• Law enforcement may be notified if the event has
potential law enforcement implications
Level 3 – Response
• Emergency Health Response is necessary
Biological Incident Annex is activated
• KDHE Department Operations Center is activated
• Limited outside resources needed
• Decision makers are able to mobilize internal
resources to identify, contain, or mitigate the
disease
• Public Information is handled through the KDHE
Office of Communications
• KDHE Public Information Phone Bank may be
activated
Level 4 – Full-Scale Activation
• Resources outside of public health and medical
agencies are needed
• State Emergency Operations Center is activated
• KDHE Department Operations Center is activated
• Kansas State Emergency Operations Center
(SEOC) Team is notified and activated as
necessary
• Governor may issue a proclamation declaring a
state of disaster emergency
• Federal resources may be requested (e.g., SNS,
NDMS)
• Joint Information Center is staffed and
operational
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 61
Appendix B – Crosswalk of Activities
Response
Phases
I
Normal
Operations
II
Watch
III
Response
IV
Full-Scale
Activation
V
Recovery
WHO
Pandemic Phases
Interpandemic
Phase
Alert Phase Pandemic Phase Pandemic Phase Transition Phase
CDC Interval Investigation Recognition
Initiation,
Acceleration,
Deceleration
Initiation,
Acceleration,
Deceleration
Preparation
Community
Resilience and
Incident
Management
Planning with state
agencies and task
forces. Training
and exercising of
plan.
Notify KDEM and
other partners.
Activate Plan.
Minimal or Extended
Response. DOH
Resources. DOC and
activated to Level 3,
request KDEM
Liaison
Ask for Governor’s
Declaration of
Emergency
Demobilization
and conduct
AAR.
Biosurveillance Normal operation
Broad
dissemination of
case definition for
active case finding
of novel virus in
KS resident.
Case finding of
pandemic strain in KS
residents
Case investigation
limited to
determining age-
specific attack rates,
morbidity and
mortality
Epidemiological
studies as
outlined in the
plan
Return to normal
case
investigation.
Surge
Management
Review and revise
hospital
emergency
operations plans.
Train and exercise
surge portions of
plan.
Community
planning for
alternate care sites.
Review applicable
surge sections of
plan. Revise as
necessary with
community
partners.
Increase frequency
of HAvBED
updates by Kansas
hospitals
Incorporate best
practices from CDC,
KDHE, HHS and
APIC.
Initiate behavioral
health response
community.
Use of Alternate
Care facilities
considered.
Use of Modified
Protocols for
Emergencies
considered
Continues until
patient load
normalizes and
disease
transmission is
interrupted.
Close Alternate
Care Sites.
Cease Modified
Protocols for
Emergencies.
Countermeasures
and Mitigation
PIPC review and
update the Vaccine
and Antiviral
Delivery section of
the plan as needed.
Prepare and
distribute Isolation
and Quarantine
Order Templates
to LHD.
Initiate vaccine
and antiviral
acquisition
Verify federal
material
distribution plans.
Advise hospitals
and clinicians of
control measures,
including
quarantine and
isolation orders for
novel virus cases.
Continue to identify
high-risk groups for
possible treatment
with antivirals and
prepare for mass
vaccination.
Review community
control measures.
Consider group
isolation measures.
Conduct mass
immunizations when
vaccine is available.
Continue treatment
with antivirals if
available.
Implement
community control
measures including
group isolation.
Assess the
effectiveness of
vaccine and
antivirals.
Review
effectiveness of
control.
Return of
durable medical
supplies.
Information
Management
Review and update
PIC plan and the
communications
KDHE PIO will
review PIC Plan
with PIPC.
KDHE PIO conducts
communication
KDHE PIO conducts
communication
KDHE PIO
reviews
communication
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 62
section of this
plan.
activities outlined in
the plan.
Situation reports
shared with
responding
organizations.
Daily phone calls with
health, medical and
response community.
activities outlined in
the PIC plan.
Situation reports
shared with
responding
organizations.
Daily phone calls
with health, medical
and response
community.
strategies used
during the
pandemic.
Appendix C – State Preparedness Committees
Commission on Emergency Planning and Response
Office of the State Fire Marshal
Kansas Department of Health and Environment:
Division of Environment
Kansas Department of Health and Environment:
Division of Public Health
Kansas Department of Transportation
Kansas Highway Patrol
Kansas Adjutant General’s Department
Kansas Department of Commerce
Kansas Bureau of Investigation
Kansas Department of Agriculture
Representative of:
Counties
Cities
Businesses and Industries
Broadcasting
Agriculture, crop or livestock
Transportation, trucking or rail
Energy
Law enforcement officers
Fire fighters
County emergency managers
Emergency medical services
Public works services hospitals
Public health
Tribes of Kansas individuals with disabilities
Kansas Homeland Security Councils
Appendix D – Coordination List
COORDINATION OF PANDEMIC INFLUENZA PREPAREDNESS WITH STATE AND
FEDERAL AGENCIES
State Agencies
Kansas Department of Health and Environment (KDHE)
Kansas Department of Transportation (KDOT)
Kansas Department of Aging and Disability Services (KDADS)
The Kansas National Guard (KSNG)
The Kansas Division of Emergency Management (KDEM)
The Kansas Board of Emergency Medical Services (KBEMS)
Kansas Department of Corrections (KDOC)
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 63
Kansas Highway Patrol (KHP)
Kansas Department of Agriculture (KDA)
Kansas Board of Pharmacy
Divisions and bureaus within the Kansas Department of Health and Environment
The Office of the Secretary
The Division of Public Health
The Kansas Health and Environmental Laboratories (KHEL)
The Bureau of Epidemiology and Public Health Informatics (BEPHI)
The Bureau of Disease Control and Prevention (BDCP)
The Bureau of Family Health (BFH)
The Bureau of Health Promotion (BHP)
The Bureau of Community Health Systems (BCHS)
Federal Agencies
The Department of Health and Human Services (HHS)
The Centers for Disease Control and Prevention (CDC)
The Federal Emergency Management Agency (FEMA)
The Food and Drug Administration (FDA)
The Department of Homeland Security (DHS)
The United States Department of Agriculture (USDA)
Other Agencies and Organizations
Other State Health Departments
Kansas Veterinary Diagnostic Laboratory
Kansas Hospital Association
Kansas Medical Society
Salvation Army
American Red Cross
Kansas Association of Local Health Departments
Kansas Pharmacists Association
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 64
Appendix E – Family (Home) Care for Symptomatic Individuals
Home care will be the predominant mode of care for most people infected with influenza. During
the Pandemic Alert Period, individuals should discuss with their healthcare provider specific
recommendations for both vaccination and chemoprophylaxis.
The single best way to prevent influenza is to get vaccinated each fall. In the absence of vaccine,
however, there are other ways to protect against influenza. Only oseltamivir and zanamivir are
currently recommended for seasonal influenza because of high levels of resistance to amantidine
and rimantidine among currently circulating influenza A viruses. Adamantine (amantidine and
rimantidine) have limited use in the prevention of influenza. Zanamivir is also used for
chemoprophylaxis. All of these drugs are prescription drugs, and a doctor should be consulted
before their use.
The public should receive frequent and repetitive health communications that emphasize the
simple steps that individuals and families may take to prevent the spread of respiratory illnesses
like influenza:
• Avoid close contact with people who are sick.
• Wash hands often. If sick, stay at home and keep at least three feet away from others.
• Cover mouth and nose with a tissue when coughing or sneezing.
Individuals who are cared for at home should:
• Get plenty of rest.
• Drink a lot of fluids.
• Avoid using alcohol and tobacco.
• Consider taking over-the-counter medications to relieve the symptoms of influenza (but
never give aspirin to children or teenagers who have influenza-like symptoms).
• Stay home and avoid contact with other people.
• Cover nose and mouth with a tissue when you coughing or sneezing.
In a pandemic influenza, some individuals who are cared for at home may develop
complications. Should complications develop, these individuals should seek medical care
immediately, either by calling the doctor or going to an emergency room. Upon arrival, the
receptionist or nurse should be told about the symptoms so that precautions can be taken
(providing a mask and or separate area for triage and evaluation).
Warning signs to seek urgent medical care:
In children, these include:
• High or prolonged fever
• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Changes in mental status, somnolence, irritability
• Seizures
• Influenza-like symptoms improve but then return with fever and worse cough
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 65
• Worsening of underlying chronic medical conditions (for example, heart or lung disease,
diabetes)
In adults, these include:
• High or prolonged fever
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest
• Near-fainting or fainting
• Confusion
• Severe or persistent vomiting
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 66
Appendix F – Internet Sites Referenced
CDC FluAid
FluAid is a test version of software created by programmers at the Centers for Disease Control
and Prevention (CDC). It is designed to assist state and local level planners in preparing for the
next influenza pandemic by providing estimates of potential impact specific to their locality.
https://www.cdc.gov/flu/pandemic-resources/tools/fluaid.htm
Kansas State Statutes (index)
http://www.kslegislature.org/li_2016/b2015_16/statute/
World Health Organization Pandemic Preparedness
https://www.who.int/influenza/preparedness/pandemic/en/
Kansas Response Plan (KRP)
http://www.kansastag.gov/AdvHTML_doc_upload/2017%20KRP%20FINAL.pdf
Mass Clinic (SNS) Standard Operating Guide Template for Local Health Departments
http://www.kdheks.gov/cphp/operating_guides.htm
Federal website with Pandemic Influenza planning tools and resources
http://www.pandemicflu.gov/
Valuable Links from pandemicflu.gov
Antiviral Allocations for each state: https://www.cdc.gov/flu/pandemic-resources/national-
strategy/planning-guidance/
National Strategy for Pandemic Influenza: Implementation Plan
https://www.cdc.gov/flu/pandemic-resources/pdf/pandemic-influenza-implementation.pdf
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 67
Appendix G – HHS Vaccine Priority Recommendations
Table 2. Vaccination target groups, estimated populations, and tiers for severe, moderate and less
severe pandemics as defined by the Pandemic Severity Index (PSI) Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Not targeted
Category Target group Estimated
number Severe Moderate
Less
severe
Homeland and
national
security
Deployed and mission critical pers. 700,000
Essential support & sustainment pers.
Intelligence services
Border protection personnel
National Guard personnel
Other domestic national security pers.
650,000
150,000
100,000
500,000
50,000
Other active duty & essential suppt. 1,500,000
Healthcare
and
community
support
services
Public health personnel
Inpatient healthcare providers
Outpatient and home health providers
Healthcare providers in LTCFs
300,000
3,200,000
2,000,000
800,000
Community suppt. & emergency mgt. 600,000
Other important healthcare personnel 500,000
Critical
infrastructure
Emergency Medical Service personnel
Law enforcement personnel
Fire services personnel
Mfrs of pandemic vaccine & antivirals
Key government leaders
2,000,000
50,000
50,000
Electricity sector personnel
Natural gas personnel
Communications personnel
Water sector personnel
Critical government personnel
1,900,000
to 4,400,000
Transportation sector personnel
Food and agriculture sector personnel
Banking and finance personnel
Pharmaceutical sector personnel
Chemical sector personnel
Oil sector personnel
Postal and shipping personnel
Other important government personnel
1,400,000
to 3,500,000
General
population
Pregnant women
Infants & toddlers 6–35 mo old
3,100,000
10,300,000
Household contacts of infants < 6 mo
Children 3–18 yrs with high risk cond.
4,300,000
6,500,000
Children 3–18 yrs without high risk 58,500,000
Persons 19–64 with high risk cond. 36,000,000
Persons >65 yrs old 38,000,000
Healthy adults 19–64 yrs old 121,800,000
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 68
Figure 1. Vaccination tiers and target groups for a severe pandemic. This figure illustrates how
vaccination is administered by tiers until the entire U.S. population has had the opportunity to be
vaccinated, and how tiers integrate target groups across the four categories balancing vaccine
allocation to occupationally defined groups and the general population.
Vaccination tier
tiers
23 million
17 million
64 million
74 million
122 million
300
M
Tier 1 Tier 2 Tier 3 Tier 4 Tier
5
Rest of population
Critical occupations
- Deployed forces - Critical healthcare
- EMS
- Fire - Police
- Govt. leaders High risk population - Pregnant women - Infants - Toddlers
Critical occupations - Military support
- Border protection
- National Guard - Intelligence services
- Other natl. security
- Community services - Utilities
- Communications
- Critical govt. High risk population
- Infant contacts
- High risk children
Critical occupations
- Other active duty - Other healthcare
- Other CI sectors
- Other govt. High risk population - Healthy children
High Risk Populations - High risk adults - Elderly
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 69
Appendix H – Local Pandemic Influenza Response Checklist
ACTION
Interpandemic Period
Goals: Strengthen influenza pandemic preparedness, Minimize the risk of transmission to humans; detect and report such
transmission rapidly if it occurs
Establish a local healthcare task force as a focus for planning, preparedness and coordinated response. The
task force should include representatives from hospitals, physician and nursing organizations, home
healthcare, long-term care facilities, pharmacists, EMS and local public health officials.
Develop strategies to increase the demand for influenza vaccine among your county’s residents and especially
healthcare workers.
Continue to develop and refine the local Mass Dispensing, Community Disease Containment and Public
Information and Communication SOGs.
Work with the local chamber of commerce and large employers to increase awareness in the community.
Conduct training and exercises to ensure the local Mass Dispensing, Community Disease Containment and
Public Information and Communication SOGs are operational.
Educate health department staff and healthcare providers about pandemic influenza.
Estimate target populations (priority groups) of essential personnel, including healthcare workers, first
responders and public safety workers.
Pandemic Alert Period
Goal: Ensure rapid characterization of the new virus subtype and early detection, notification and response to additional
cases. Contain the new virus within limited foci or delay spread to gain time to implement preparedness measures,
including vaccine development Maximize efforts to contain or delay spread, to possibly avert a pandemic, and to gain time
to implement pandemic response measures
Review Local Response Plan, Emergency Support Function 8 – Health and Medical Annex.
Review the Mass Dispensing, Community Disease Containment and Public Information and Communication
SOGs, ensure contacts are updated and potential vaccination clinic facilities are available.
Review local Point of Dispensing sites on Kansas Countermeasure Response Administration System and
update, if necessary.
Convene local health task force and brief on the status of the Pandemic Alert and local preparedness efforts.
Review message maps relating to pandemic influenza and make sure they are current.
Review priority group estimates.
Ensure Mass Dispensing SOG addresses vaccine distribution to tribal entities, military installations, and
correctional facilities, if applicable.
Ensure city police departments and the county sheriff’s offices are aware of the potential for civil unrest to
occur in the event of a pandemic.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 70
Meet with adjoining jurisdictions to ensure actions will be coordinated in Phase 6. Special considerations
include: priority group recommendations, vaccination clinic operations (hours of operation, locations, policies,
and forms).
Local health task force reviews the priority group recommendation of the KDHE and provides guidance to
local health officer on any changes.
Once priority groups are identified, estimate the number of local citizens in each group.
Health department ensures that all agencies and volunteers tasked in the plan are aware of the Pandemic Alert
Phase and the potential for escalation.
Ensure all personnel who may have contact with the media are trained on the message maps.
Ensure all media contacts are up to date.
Log into WebEOC and familiarize staff with the system.
Review security component of the Mass Dispensing SOG and ensure security assets are available and briefed.
Pandemic Alert Period
Goal: Minimize the impact of the pandemic
Activate local Emergency Operations Plan (EOP), Emergency Support Function 8.
Activate local Emergency Operations Center (EOC) and the local Joint Information Center (JIC).
Administer influenza vaccine as it becomes available. Ensure a second dose of vaccine is administered if
necessary.
Assist KDHE with obtaining data to determine age-specific attack rates, morbidity and mortality.
Work with KDHE to determine vaccine efficacy.
Appendix I – State Pandemic Influenza Checklist
ACTION
Interpandemic Period
Goal: Strengthen influenza pandemic preparedness, Minimize the risk of transmission to humans; detect and report such
transmission rapidly if it occurs
Establish a state task force as a focus for planning, preparedness and coordinated response. The task force
should include representatives from hospitals, physician and nursing organizations, home healthcare, long-
term care facilities, pharmacists, EMS and local public health officials.
Develop strategies to increase the demand for influenza vaccine among state residents; especially healthcare
workers.
Continue to develop and test the KDHE Internal Operating Guides.
Kansas Pandemic Influenza Preparedness and Response Plan Version 2.3.2 January 2020 Page 71
Ensure all KDHE – Division of Public Health staff with response roles are trained on the National Incident
Management system. (Complete IS-700 through KS TRAIN or provide certificate to training staff)
Establish the Pandemic Influenza Preparedness Committee (PIPC) to draft and maintain the plan for a
coordinated state response to an occurrence of pandemic influenza.
Conduct exercises to test the state’s ability to respond to large-scale outbreaks at least annually.
Continue passive surveillance of influenza-like illness using the ILINet Surveillance System.
KHEL will continue to isolate and sub-type influenza viruses year round.
Continue to transmit information on influenza-like illness and influenza viruses isolated to CDC.
Continue to conduct training and exercises to ensure the plan and corresponding SOGs are operational.
Educate health department staff and healthcare providers about pandemic influenza.
Estimate target populations (priority groups) of essential personnel, including healthcare workers, first
responders and public safety workers.
Continue to conduct laboratory and disease surveillance activities described in Phase 1.
Pandemic Alert Period
Goal: Ensure rapid characterization of the new virus subtype and early detection, notification and response to additional
cases. Contain the new virus within limited foci or delay spread to gain time to implement preparedness measures,
including vaccine development Maximize efforts to contain or delay spread, to possibly avert a pandemic, and to gain time
to implement pandemic response measures
Review the Kansas Response Plan to include: Emergency Support Function 8 – Health and Medical Annex
and the Biological Incident Annex.
Review Mass Dispensing SOG, ensure contacts are updated and potential vaccination clinic facilities and state
warehouses are available.
Review local Point of Dispensing sites on Kansas Countermeasure Response Administration System and
ensure local entities have updated, if necessary.
Convene state health task force and brief on the status of the Pandemic Alert and local preparedness efforts.
Review message maps relating to pandemic influenza and make sure they are current.
Review priority group estimates.
Make contact with state health departments in Missouri, Nebraska, Oklahoma and Colorado to update on
status of planning and preparedness efforts. Ensure contact numbers are updated.
Continue to conduct laboratory and disease surveillance activities described in Phase 1. Monitor and institute
recommendations from CDC for any additional surveillance activities that should be undertaken given the
specific circumstances.
Ensure state law enforcement agencies (KBI and KHP) are aware of the potential for civil unrest to occur in
the event of a pandemic.
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Test the functionality of the health and medical boards in WebEOC and update if needed.
Ensure pandemic influenza information is available on the KDHE website.
Activate public hotline if needed.
Begin case detection among people who have recently traveled to the outbreak area and present with
influenza-like illness or pneumonia.
Continue disease surveillance activities described in Phase 1 regardless of the time of year.
Meet with adjoining jurisdictions to ensure actions will be coordinated in Phase 6. Special considerations
include: priority group recommendations, vaccination clinic operations (hours of operation, locations, policies,
and forms).
State health task force provides the priority group recommendation to the local health officers.
KDHE collects information from the local agencies regarding the estimated numbers of people in the various
priority groups.
KDHE ensures that all agencies tasked in the plan are aware of the Pandemic Alert Phase and the potential for
escalation.
Ensure all personnel who may have contact with the media are trained on message maps.
Ensure all media contacts are up to date.
Log into WebEOC and familiarize staff with the system.
Review security component of the Mass Dispensing SOG and ensure security assets are available and briefed.
Educate public health officials, elected officials and the media about what information will and will not be
available during a pandemic.
Assess the need to screen travelers arriving in the U.S. from affected countries.
Investigate the epidemiology of all early cases either originating in the U.S. or that are imported into the
country.
Recommend that hospitals and emergency departments increase laboratory testing of influenza, particularly
those who may have had recent exposure at the site of an outbreak.
The Bureau of Epidemiology & Public Health Informatics will investigate outbreaks and increases in ILIs.
Pandemic Alert Period – Phase 6
Goal: Minimize the impact of the pandemic
Activate Kansas Response Plan (KRP), Biological Incident Annex.
Activate State Emergency Operations Center (SEOC) and the Joint Information Center (JIC).
Distribute or administer influenza vaccine as it becomes available. Ensure a second dose of vaccine is
administered if necessary.
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Assist local health departments with data collection to determine age-specific attack rates, morbidity and
mortality rates.
Work with CDC to determine vaccine efficacy.
Monitor health impacts of the pandemic including deaths and hospitalizations from influenza.
Assess the quality of surveillance and make recommendations for improvement during the period between
pandemic waves and after the pandemic.
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Appendix J – Community Disease Containment Standard Operating Guide
http://www.kdheks.gov/cphp/operating_guides.htm
The link provided directs the user to the Community Disease Containment Standard Operating
Guide template developed by KDHE. Included on this website is a template Standard Operating
Guide (SOG) for local health department and community use in planning for any disease
outbreak, including pandemic influenza.
Appendix K – Diagnostic Assays during Pandemic Influenza
Rapid Diagnostic Tests
1. Several rapid diagnostic test kits based on antigen detection are commercially available
for Influenza. Laboratories in outpatient settings and hospitals can use these tests to
detect Influenza viruses within 30 minutes. Some tests can detect influenza A viruses
(including avian strains); others can detect influenza A and B viruses without
distinguishing between them and some can distinguish between influenza A and B
viruses. The type of specimens used in these tests (i.e., nasopharyngeal swabs, nasal
swab, throat swab, or nasal aspirate,) may also vary. RT-PCR and rapid diagnostic tests
do not require in vitro growth or isolation of virus. During a pandemic, rapid diagnostic
tests will be widely used to distinguish influenza A from other respiratory illnesses.
a. Biocontainment level: BSL-2
2. RT-PCR Subtyping
a. Influenza specimens may also be typed and subtyped using real-time RT-PCR,
which does not require in vitro growth or isolation of virus. CDC has trained
scientists from all 50 states to use RT-PCR subtyping to identify human and avian
HA subtypes of public health concern. These methods are in place for year-
round surveillance of influenza-like-illness (ILI) and can be ramped up for surge
capacity during an outbreak or pandemic event. Currently only nasopharyngeal
and nasal swabs are accepted for testing with this method; additional specimen
types may be added on an emergency use basis according to the discretion of the
CDC.
b. Biocontainment level: BSL-2
3. Virus Isolation
a. Virus isolation—growing the viral strain in cell culture for Influenza diagnostics
is considered to be a best practice because it confirms that the virus is infectious.
During a pandemic, virus isolation followed by antigenic and genetic
(sequencing) analysis will be used to characterize the earliest pandemic isolates,
as well as to monitor their evolution during the pandemic. Laboratories that
participate in the WHO Global Influenza Surveillance Network typically use virus
isolation followed by hemagglutination inhibition (HAI), IFA staining, or RT-
PCR to monitor circulating seasonal strains of Influenza. If clinical and
epidemiologic data suggest that a human case of influenza might be due to
infection with avian influenza A (H5N1) or another highly pathogenic avian
influenza strain (see Box 3), the virus should not be cultured except under BSL-3
conditions with enhancements. Laboratories that lack BSL-3 enhanced facilities
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may either perform RT-PCR subtyping using BSL-2 containment procedures or
send the specimen to CDC for isolation and characterization.
b. Biocontainment level: Inter-pandemic and Pandemic Alert Periods – BSL-3 with
enhancements; Pandemic Period – BSL-2
c. KHEL does not perform these tests
4. Immunoflorescence Antibody Staining
a. IFA staining following virus isolation can be used to identify influenza types (A,
B) and influenza A HA subtypes using a panel of specific antisera. In some cases,
IFA can be used for direct testing of cells pelleted from original clinical samples.
CDC’s Influenza Branch produces and distributes a reagent kit to WHO-
collaborating laboratories that includes conjugated monoclonal antibodies for
typing and subtyping currently circulating influenza viruses by IFA. Many
laboratories use commercially available reagents to type influenza viruses by
direct immunofluorescence tests (DFA).
b. Immunofluorescence Assays
Biocontainment level: BSL-2 when performed directly on clinical specimens; if
used on cultures for earlier detection of virus, biocontainment recommendations
for viral culture apply
5. Serological Tests
a. Tests based on detection of antibodies in patient sera—e.g., enzyme-linked
immunosorbent assay (ELISA), HAI, and microneutralization assay—can be used
to retrospectively confirm influenza infection. Although microneutralization assay
is the most comprehensive test for detection in humans of antibodies to avian
influenza viruses, it is available in only a few state public health laboratories.
b. Hemagglutination Inhibition (HAI)
Biocontainment level: BSL-2
c. KHEL does not perform these tests.
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Appendix L – KDHE ILINet Sites